腹股沟复杂创面的临床评估与修复策略

杜伟力; 刘子熙; 熊枫; 曹彤瑜; 张慧君; 车可心; 沈余明

doi:10.3760/cma.j.cn501225-20260505-00182

腹股沟复杂创面的临床评估与修复策略

doi: 10.3760/cma.j.cn501225-20260505-00182

首都医科大学附属北京积水潭医院烧伤整形与创面修复科,北京　　100035

基金项目:

北京市属医院科研培育计划 PX2024016

北京积水潭医院学科骨干 XKGG202209

详细信息

通讯作者:
沈余明,Email：shenyuming1963@163.com

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出版历程
- 收稿日期: 2026-05-05

Clinical evaluation and repair strategies for complex inguinal wounds

Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China

Funds:

Research and Cultivation Program of Beijing Capital Hospital PX2024016

Subject Backbone of Beijing Jishuitan Hospital XKGG202209

More Information

Corresponding author: Shen Yuming, Email: shenyuming1963@163.com

摘要

摘要: 目的探讨腹股沟复杂创面的临床评估与修复策略。方法该研究为回顾性病例系列研究。2020年9月—2025年12月,首都医科大学附属北京积水潭医院收治15例符合入选标准的腹股沟复杂创面患者,其中男10例、女5例,年龄为12~79岁。术前通过病史询问、体格检查及多种辅助检查精准评估腹股沟区的重要组织结构受累及情况及感染情况,及时处理股动脉相关情况后,再行精准清创,清创后腹股沟创面面积为11.0 cm×4.0 cm~20.0 cm×9.0 cm。根据清创后基底情况,选择血运丰富的组织瓣填充创腔、封闭创面。记录创面累及股血管情况、人工血管外露情况及保留或去除情况、放射治疗导致的创面患者的股动脉处理情况,采用的组织瓣类型及大小、供瓣区创面封闭方式,术前创面分泌物标本细菌培养结果及术中创面组织病理学检查结果。术后2周,观察组织瓣成活情况及创面愈合情况。随访时,观察组织瓣外形、创面复发情况、股动脉通畅情况、患肢肿胀情况、供瓣区瘢痕形成情况及腹直肌肌皮瓣供区腹壁疝发生情况。结果腹股沟创面全部累及股血管。4例患者人工血管外露,其中人工血管予以保留者3例、去除者1例。术前放置覆膜支架者2例,术中切除股动脉并移植人工血管者1例；其余患者股动脉均成功保留,未出现破裂。腹股沟创面采用胸脐皮瓣联合腹直肌肌皮瓣修复者11例,采用阔筋膜张肌肌皮瓣联合缝匠肌肌瓣修复者1例,采用阔筋膜张肌肌皮瓣联合股直肌肌瓣修复者1例,采用带蒂股前外侧皮瓣嵌合股外侧肌肌瓣修复者2例。组织瓣面积为13.0 cm×6.0 cm~26.0 cm×14.0 cm。仅1例患者供瓣区创面移植断层皮片封闭,其余患者供瓣区创面直接缝合封闭。术前创面分泌物标本细菌培养结果显示,7例患者为单一细菌感染,8例患者为2种细菌混合感染。术中创面组织病理学检查结果均为炎性改变,未见肿瘤成分。术后2周,所有患者组织瓣完全成活,创面愈合良好。术后随访6个月~3年,大部分组织瓣外形良好,小部分稍显臃肿；创面未复发,CT血管成像检查显示14例患者股动脉通畅,9例术前患肢肿胀患者消肿明显。1例供瓣区创面移植皮片患者供瓣区未见明显瘢痕；其余14例患者供瓣区有轻微线性瘢痕。所有患者腹直肌肌皮瓣供区未发生腹壁疝。结论对于腹股沟复杂创面,通过术前精准评估大血管、人工血管和软组织感染情况,准确处理血管,术中能精准清创,然后采用血运丰富的组织瓣封闭创面,可获得良好的临床修复效果。
- 腹股沟 /
- 外科皮瓣 /
- 外科手术 /
- 复杂创面 /
- 创面修复
Abstract: Objective To explore the clinical evaluation and repair strategies for complex inguinal wounds. Methods This study was a retrospective case series study. Between September 2020 and December 2025, 15 patients with complex inguinal wounds meeting the inclusion criteria were admitted to Beijing Jishuitan Hospital of Capital Medical University. There were 10 males and 5 females, aged 12 to 79 years. Preoperatively, detailed medical history inquiry, physical examination, and multiple auxiliary examinations were performed to precisely evaluate the involvement of vital anatomical structures and infectious status in the inguinal region. After timely management of femoral artery lesions, precise debridement was carried out. The sizes of inguinal wounds after debridement ranged from 11.0 cm×4.0 cm to 20.0 cm×9.0 cm. According to the wound bed conditions after debridement, well-vascularized tissue flaps were selected to obliterate the wound cavity and achieve wound closure. The following data were recorded, including the involvement of femoral vessels by the wound, the exposure and retention or removal of prosthetic vascular grafts, management of the femoral artery in patients with radiation-induced wounds, type and size of the adopted tissue flaps, closure methods of the donor site wounds, results of bacterial culture of preoperative wound exudate samples, and intraoperative histopathological examination of wounds. The tissue flaps survival and wound healing were observed at postoperative two weeks. During follow-up, the appearance of tissue flaps, recurrence of wounds, patency of femoral artery, swelling of the affected limb, scar formation of the donor sites, and occurrence of abdominal wall hernia at the donor site of rectus abdominis musculocutaneous flap were observed. Results All inguinal wounds involved the femoral vessels. Exposure of the prosthetic vascular graft was observed in 4 patients, among which the prosthetic vascular graft was preserved in three patients and removed in one patient. Two patients received preoperative covered stent implantation, one patient underwent intraoperative femoral artery resection and implantation with the prosthetic vascular graft, and femoral artery was successfully preserved without rupture in the remaining patients. The inguinal wounds were repaired with thoracoumbilicus flap combined with rectus abdominis musculocutaneous flap in 11 patients, tensor fasciae latae musculocutaneous flap combined with sartorius muscle flap in one patient, tensor fasciae latae musculocutaneous flap combined with rectus femoris muscle flap in one patient, and pedicled anterolateral thigh flap chimerized with vastus lateralis muscle flap in two patients. The sizes of tissue flaps ranged from 13.0 cm×6.0 cm to 26.0 cm×14.0 cm. Only the donor site wound in one patient was covered with split-thickness skin graft, and the donor site wounds in remaining 14 patients were closed by primary suture. Bacterial culture of preopertive wound exudate samples showed monomicrobial infection in 7 patients and mixed infection of two types of bacteria in 8 patients. Intraoperative histopathological examinations of wounds revealed inflammatory changes without neoplastic component. The tissue flaps in all patients survived completely and the wounds healed well at postoperative two weeks. During follow-up of 6 months to 3 years, most of the tissue flaps maintained satisfactory appearance, while a small number of tissue flaps presented mild bulkiness. No wound recurrence was observed. Computed tomography angiography confirmed patent femoral arteries in 14 patients, and obvious relief of preoperative lower limb swelling was achieved in 9 patients. The donor site with skin grafting showed unremarkable scarring in one patient, while mild linear scars were noted at the donor sites in the other 14 patients. No abdominal wall hernia occurred at the donor sites of rectus abdominis musculocutaneous flaps. Conclusions For complex inguinal wounds, optimal clinical repair outcomes can be achieved via preoperative precise evaluation of major vessels, prosthetic vascular grafts, and soft tissue infection, and adequate vascular intervention, intraoperative precise debridement, followed by wound closure using well-vascularized tissue flaps.
- Groin /
- Surgical flaps /
- Surgical procedures, operative /
- Complex wound /
- Wound repair
杜伟力：患者管理、手术实施、文章撰写；刘子熙、熊枫、曹彤瑜、张慧君：患者管理、手术实施、数据收集；车可心：病例图片制作和修改；沈余明：指导手术的设计与实施过程、指导文章撰写

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图 1 采用阔筋膜张肌肌皮瓣联合缝匠肌肌瓣修复例1患者右腹股沟创面的效果。1A.入院时腹股沟创面,可见股动脉外露,周围软组织感染、坏死；1B.入院时创面区域的CT血管成像显示股动脉通畅；1C.清创后创面,可见股动脉外露；1D.术中设计同侧阔筋膜张肌肌皮瓣；1E.术中切取缝匠肌肌瓣；1F.术中用缝匠肌肌瓣覆盖股动脉；1G.术中用阔筋膜张肌肌皮瓣覆盖腹股沟创面；1H.术后6个月随访时,组织瓣存活良好,创面愈合良好

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图 2 采用胸脐皮瓣联合腹直肌肌皮瓣修复例2患者左腹股沟创面的效果。2A.入院时腹股沟创面,基底污秽；2B.磁共振成像显示股动脉外露、感染；2C.术中切除严重感染股动脉,设计左侧胸脐皮瓣联合腹直肌肌皮瓣；2D.将组织瓣通过皮下隧道转移至腹股沟区,用腹直肌肌皮瓣覆盖人工血管；2E.术后7个月随访时,CT血管成像显示人工血管通血良好；2F.术后7个月随访时,创面愈合良好,组织瓣血运良好,稍显臃肿

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