Clinical efficacy of pedicled double perforator deep inferior epigastric artery perforator flap in reconstructing defects following resection of cutaneous malignant tumors
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摘要:
目的 探讨带蒂腹壁下动脉双穿支皮瓣修复腹股沟或大腿部位邻近主干血管和/或神经的皮肤恶性肿瘤切除后软组织缺损的临床效果。 方法 该研究为回顾性病例系列研究。2016年06月—2023年06月,解放军联勤保障部队第九八八医院烧伤整形与创面修复科收治12例符合入选标准的腹股沟区或大腿部位皮肤恶性肿瘤患者,其中男8例、女4例,年龄58~76岁。本组患者肿瘤组织侵袭深度均近主干血管和/或神经。对肿瘤组织行根治性扩大切除术,术后皮肤软组织缺损面积为16 cm×13 cm~37 cm×17 cm。设计并切取以脐旁穿支及胸脐穿支为蒂的腹壁下动脉双穿支皮瓣,面积为15 cm×14 cm~38 cm×18 cm。将皮瓣经皮下隧道转移至受区创面并缝合固定。8例患者供瓣区创面行直接缝合；其余4例则先行拉拢缝合缩小创面,再以VSD敷料覆盖,待二期缝合。术后观察皮瓣血运及成活情况、血管危象发生情况及供受区创面愈合情况。记录手术时长和住院时间。术后随访时,观察患者肿瘤复发情况、皮瓣外形及供区瘢痕情况,并评估腹壁功能是否受影响。 结果 术后12例患者皮瓣血运良好,顺利成活,无血管危象发生；供受区创面均顺利愈合。患者手术时长为2~3 h,住院时间为15~24 d,平均18.6 d。术后随访1~6年,未见局部肿瘤复发；皮瓣稍臃肿,但弹性良好,质地与周围组织无明显差异；供区仅遗留线性瘢痕,对腹壁功能无明显影响。 结论 对于腹股沟或大腿部位邻近主干血管和/或神经的皮肤恶性肿瘤根治性切除后大面积软组织缺损,可选择带蒂腹壁下动脉双穿支皮瓣进行修复,该皮瓣面积大,可实现有效修复,同时对供区外观、功能影响小。 Abstract:Objective To investigate the clinical efficacy of pedicled double perforator deep inferior epigastric artery perforator flap in reconstructing soft tissue defects following resection of cutaneous malignant tumors in the groin or thigh with adjacent major vessels and/or nerves. Methods This was a retrospective case series study. From June 2016 to June 2023, 12 patients with cutaneous malignant tumors in the groin or thigh who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the 988th Hospital of the Joint Logistics Support Force of PLA. The cohort included 8 males and 4 females, aged 58 to 76 years. In all patients, tumor invasion depth approached the major vessels and/or nerves. Radical extended resection was performed for the tumors, resulting in postoperative skin and soft tissue defects ranging from 16 cm × 13 cm to 37 cm × 17 cm. A pedicled double perforator deep inferior epigastric artery perforator flap based on the paraumbilical and thoracic paraumbilical perforators was designed and harvested, with flap dimensions ranging from 15 cm × 14 cm to 38 cm × 18 cm. The flaps were transferred to the recipient site through a subcutaneous tunnel and sutured in place. Primary closure of the donor site was achieved in 8 patients; in the remaining 4 patients, the donor site wound was first reduced by approximation sutures, then covered with vacuum sealing drainage (VSD) dressing, with secondary closure performed at a later stage. Postoperative observations included flap blood supply, flap survival, occurrence of vascular crisis, and healing of donor and recipient sites. Operative duration and length of hospital stay were recorded. During follow-up, tumor recurrence, flap contour, donor site scar, and abdominal wall function were assessed. Results All 12 patients achieved good flap blood supply and uneventful survival, with no vascular crisis. Both donor and recipient sites healed successfully. Operative duration ranged from 2 to 3 hours, and hospital stay ranged from 15 to 24 days, with a mean of 18.6 days. During a follow-up period of 1 to 6 years, no local tumor recurrence was observed. The flaps were slightly bulky but demonstrated good elasticity and no significant difference in texture from the surrounding tissue. The donor site only exhibited a linear scar, with no significant impact on abdominal wall function. Conclusions For extensive soft tissue defects following radical resection of cutaneous malignant tumors in the groin or thigh adjacent to major vessels and/or nerves, the pedicled double perforator deep inferior epigastric artery perforator flap is a viable reconstructive option. This flap provides a large surface area for effective reconstruction while minimizing the impact on donor site aesthetics and function. -
Key words:
- Perforator flap /
- Microsurgery /
- Skin neoplasms /
- Malignant complex wounds /
- Wound repair
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参考文献
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图 1 采用带蒂腹壁下动脉双穿支皮瓣修复例1患者右大腿内侧脂肪肉瘤根治性扩大切除后创面的效果。1A.术前右大腿内侧脂肪肉瘤创面情况；1B.磁共振成像检查可见肿瘤侵蚀深度接近股动脉、股静脉及股神经；1C.术中深腔创面经亚甲蓝浸染后,确定扩大切除范围；1D.术中,根治性扩大切除脂肪肉瘤后创面情况；1E.术中设计带蒂腹壁下动脉双穿支皮瓣；1F.术中分离显露脐旁穿支及胸脐穿支；1G.皮瓣切取后经皮下隧道转移至受区,皮瓣血运良好；1H.术后18个月随访时,皮瓣稍臃肿但质地与周围组织无明显差异,供区仅遗留线性瘢痕
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