受区单一静脉双回流系统在股前外侧组织瓣游离移植修复头皮高压电烧伤创面中的临床应用效果

聂广辰; 郑旺; 郝旭光; 李宗瑜; 邵铁滨; 牟彬; 刘勇; 孟祥悦; 冯晶辉; 吴碧楠

doi:10.3760/cma.j.cn501225-20250220-00074

受区单一静脉双回流系统在股前外侧组织瓣游离移植修复头皮高压电烧伤创面中的临床应用效果

doi: 10.3760/cma.j.cn501225-20250220-00074

1.
哈尔滨市第五医院骨科,哈尔滨　　150040
2.
哈尔滨市第五医院烧伤整形与创面修复科,哈尔滨　　150040
3.
哈尔滨学院校医院,哈尔滨　　150076
4.
哈尔滨市第五医院全科医疗,哈尔滨　　150040

基金项目:

黑龙江省卫生健康委医药卫生科研课题 20230404070015

详细信息

通讯作者:
聂广辰,Email：surgeon626@163.com

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出版历程
- 收稿日期: 2025-02-20

Clinical efficacy of free anterolateral thigh tissue flap transplantation with a single-vein dual-drainage system at recipient site in repairing scalp high-voltage electrical burn wounds

1.
Department of Orthopedics, the Fifth Hospital of Harbin, Harbin 150040
2.
Department of Burns, Plastic and Wound Repair, the Fifth Hospital of Harbin, Harbin 150040, China
3.
Harbin University Health Center, Harbin 150076, China
4.
Department of General Practice, the Fifth Hospital of Harbin, Harbin 150040, China

Funds:

Medical and Health Scientific Research Project of the Health Commission of Heilongjiang Province of China 20230404070015

More Information

Corresponding author: Nie Guangchen, Email: surgeon626@163.com

摘要

摘要: 目的探讨受区单一静脉双回流系统在股前外侧组织瓣游离移植修复头皮高压电烧伤创面中的临床应用效果。方法该研究为回顾性观察性研究。2015年1月—2024年8月,哈尔滨市第五医院烧伤整形与创面修复科收治5例符合入选标准的高压电烧伤致头皮软组织缺损患者,其中男4例、女1例,年龄33~64岁。清创后,患者头皮软组织缺损面积为16 cm×15 cm~21 cm×18 cm。切取包括皮肤、皮下组织、深筋膜及部分股外侧肌的组织瓣,即股前外侧组织瓣。其中,组织瓣携带的穿支为肌皮穿支者3例、肌间隙穿支者2例,其源血管均为旋股外侧动脉降支,且均包含2条伴行静脉。切取的股前外侧皮瓣面积为17 cm×12 cm~22 cm×13 cm,股外侧肌面积为创面总面积的1/4~1/3。将组织瓣携带的旋股外侧动脉降支与受区动脉端端吻合；横行离断受区静脉,将组织瓣中条件更优的一条静脉与离断静脉的近端进行顺行端端吻合,另一条静脉则与离断静脉的远端进行逆行端端吻合,构建单一静脉双回流系统。本组患者受区吻合动脉均为颞浅动脉；受区吻合静脉为耳后静脉者1例、颞浅静脉额支者2例、颞浅静脉顶支者2例。将组织瓣中的皮瓣覆盖在受区主要创面,股外侧肌延展覆盖在剩余创面,缝合创缘。直接拉拢缝合供区创面后即完成Ⅰ期创面修复。术后3周,行Ⅱ期手术：取供瓣区对侧大腿前外侧中厚皮片修复受区裸露肌肉组织。记录Ⅰ期术中组织瓣切取时间。Ⅰ期术后,观察患者组织瓣是否发生血管危象、成活情况以及供瓣区创面愈合情况。Ⅱ期术后,观察受区创面愈合情况。随访时,观察患者组织瓣外观并评估其感觉恢复情况,记录供瓣区创面是否存在感染等并发症,评估供瓣区肢体功能是否受到影响。结果 5例患者Ⅰ期术中组织瓣切取时间为32~41（37±3）min。Ⅰ期术后,组织瓣均未发生动脉或静脉危象且完全成活,供瓣区创面愈合良好；Ⅱ期术后,受区创面完全愈合。术后7~24个月随访时,患者组织瓣均无明显臃肿,质地柔软,存活良好,感觉功能得到部分恢复；供瓣区创面均无感染等并发症,且供瓣区肢体功能未受影响。结论对于受区静脉条件极度受限的高压电烧伤致头皮软组织缺损创面,采用游离股前外侧组织瓣结合受区单一静脉双回流系统进行修复,能够有效提升组织瓣静脉回流效率,降低血管危象风险,缩短手术时间,减少供区损伤。
- 烧伤,电 /
- 头皮 /
- 外科皮瓣 /
- 显微外科手术 /
- 股前外侧皮瓣 /
- 静脉吻合
Abstract: Objective To investigate the clinical efficacy of free anterolateral thigh (ALT) tissue flap transplantation with a single-vein dual-drainage system at recipient site in repairing scalp high-voltage electrical burn wounds. Methods This study was a retrospective observational study. From January 2015 to August 2024, five patients (4 males and 1 female, aged 33-64 years) with scalp defects caused by high-voltage electrical burns who met the inclusion criteria were treated at the Department of Burns, Plastic and Wound Repair of the Fifth Hospital of Harbin. After debridement, the scalp soft tissue defects of patients ranged from 16 cm×15 cm to 21 cm×18 cm. A tissue flap consisting of skin, subcutaneous tissue, deep fascia, and part of the vastus lateralis muscle was harvested and referred to as ALT tissue flap. Among the patients, the perforators included in the tissue flap were musculocutaneous perforators in three cases and septocutaneous perforators in two cases. The source vessel was consistently the descending branch of the lateral circumflex femoral artery, and each tissue flap contained two accompanying veins. The size of the harvested ALT skin flap ranged from 17 cm×12 cm to 22 cm×13 cm, with the vastus lateralis muscle area accounting for approximately 1/4 to 1/3 of the total wound area. The descending branch of the lateral circumflex femoral artery carried by the tissue flap was anastomosed end-to-end with the recipient artery. The recipient vein was transected horizontally. The vein with better conditions in tissue flap was anastomosed end-to-end anterogradely to the proximal end of the transected recipient vein, while the other vein was anastomosed end-to-end retrogradely to its distal end, thereby establishing a single-vein dual-drainage system. In all cases, the recipient artery used for anastomosis was the superficial temporal artery; the recipient veins included the posterior auricular vein in one case, the frontal branch of the superficial temporal vein in two cases, and the parietal branch of the superficial temporal vein in the other two cases. The skin paddle of the tissue flap was used to cover the main defect, while the vastus lateralis muscle was extended to cover the remaining wound, followed by wound edge suture. The stage Ⅰ wound repair was completed by directly pulling and suturing the donor site wound. At three weeks postoperatively, the stage Ⅱ procedure was performed. A split-thickness skin graft was harvested from the contralateral anterolateral thigh and used to cover the exposed muscle tissue at recipient site. The tissue flap harvesting time in the stage Ⅰ was recorded. After the stage Ⅰ surgery, the patient's tissue flap was observed for the occurrence of vascular crises and survival, the wound healing at donor sites was observed. After the stage Ⅱ surgery, the wound healing at recipient sites was observed. During follow-up, the tissue flap appearance of patients was evaluated, and sensory recovery was assessed. The complications such as infection at donor sites were recorded, and it was evaluated whether the function of the donor limb had been affected. Results The tissue flap harvesting time for the five patients in the stage Ⅰ surgery ranged from 32-41 (37±3) min. After the stage Ⅰ surgery, no arterial or venous vascular crisis occurred in any tissue flap, and all tissue flaps survived completely. The wounds at donor sites healed well. After the stage Ⅱ surgery, the wounds at recipient sites achieved complete healing. During the follow-up period of 7 to 24 months after surgery, all tissue flaps of patients exhibited no significant bulkiness, possessed soft texture, and survived completely with partial recovery of sensation. No complications such as infection were observed at donor sites, and the function of donor limbs remained unaffected. Conclusions For scalp soft tissue defects caused by high-voltage electrical burns with severely compromised recipient veins, the use of a free ALT tissue flap combined with a single-vein dual-drainage system at recipient site can effectively enhance venous outflow efficiency, reduce the risk of vascular crisis, shorten operative time, and decrease donor site morbidity.
- Burns, electric /
- Head /
- Surgical flaps /
- Microsurgery /
- Anterolateral thigh flap /
- Venous anastomosis
聂广辰：研究设计、手术操作、论文撰写、经费支持；郑旺、郝旭光、邵铁滨：手术操作、数据采集与处理；李宗瑜、牟彬、刘勇：指导研究；孟祥悦：论文修改；冯晶辉、吴碧楠：数据采集与处理

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图 1 切取游离股前外侧组织瓣示意图。1A.组织瓣（箭头指示）切取；1B.游离组织瓣覆盖创面时的状态

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图 2 受区单一静脉双回流系统在游离股前外侧组织瓣修复患者头皮高压电烧伤创面中的应用效果。2A. 头部创面清创后即刻；2B.术中设计右下肢组织瓣；2C.游离组织瓣后即刻；2D.显微镜下吻合供受区动静脉血管,构建静脉双回流系统；2E.直接拉拢缝合供区创面后即刻；2F.Ⅱ期皮片移植术后1周,创面完全愈合；2G、2H.分别为术后24个月随访时,皮瓣正面和侧面观

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