摘要
目的探讨游离旋髂浅动脉穿支皮瓣修复上肢皮肤软组织缺损的临床疗效。方法自2008年1月至2015年11月，我院收治上肢皮肤软组织缺损患者22例，前臂皮肤缺损伴有肌腱或骨外露6例，手腕部皮肤缺损伴有肌腱外露3例，手背皮肤缺损伴肌腱外露10例，手指背侧皮肤缺损伴指伸肌腱缺损3例。皮肤缺损范围为3cm×5cm-7cm×15cm，均采用吻合血管的游离旋髂浅动脉穿支皮瓣修复，切取皮瓣大小为4cm×6cm～8cm×16cm，3例指伸肌腱缺损者携带腹外斜肌腱膜重建。术后重建肌腱者外固定3周，指导患者功能锻炼康复。结果1例皮瓣因旋髂浅动脉细小，吻合后顽固性痉挛通血不良失败，改用局部皮瓣转移修复；其余21例皮瓣全部存活。术后21例获得随访，时间6～24个月。上肢、手腕、手背创面修复后皮瓣外形质地满意，无需再次手术修薄，效果满意。重建指伸肌腱者手指稍臃肿，影响手指伸屈功能，效果欠佳。结论游离旋髂浅动脉穿支皮瓣供区隐蔽，供区损伤较小，血供较可靠，皮瓣可充分利用，是修复前臂、手腕、手背皮肤缺损较理想的皮瓣之一。
Objective To investigate the clinical efficacy of using the free superficial iliac circumflex artery perforator flap to repair skin and soft tissue defects of the upper extremity. Methods Twenty-two cases of skin and soft tissue defects of the upper extremity treated between January 2008 and November 2015 were involved in this study. Among them 6 cases had forearm skin defects combined with tendon or bone exposure, 3 had skin defects around the wrist combined with tendon exposure, 10 had skin defects on the dorsum of the hand with exposure of extensor tendons, and 3 had dorsal finger skin defects with extensor tendon exposure. The size of the skin defects ranged from 3 cm × 5 cm to 7 cm × 15 cm. Vascularized free iliac circumflex artery perforator flap measuring 4 cm × 6 cm to 8 cm × 16 cm was used to repair these defects. The external oblique aponeurosis was included in the flap to reconstruct the extensor tendon defect in the finger in 3 cases, who had splint immobilization for 3 weeks before rehabilitation began. Results Intractable vascular spasm due to small caliber of the anastomosed superficial iliac circumflex artery occurred in one case that caused insufficient perfusion and flap necrosis. The wound was covered with local flap transposition. The rest 21 flaps survived uneventfully. The 21 patients were follow-up for 6 to 24 months. Flaps that covered the ann, wrist and dorsum of the hand had good appearance and texture. There was no need for flap debulking surgery. The results were satisfactory. The fingers that had flap transfer and extensor tendon reconstruct were slightly bulky, affecting finger extension and flexion. Conclusion The superficial circumflex iliac artery perforator flap is located in a hidden area of the body. Its blood supply is constant. The flap can be fully utilized. It is one of the ideal flaps for repairing soft tissue defects of the forearm, wrist and dorsum of the hand.
出处
《中华手外科杂志》
CSCD
北大核心
2016年第6期435-437,共3页
Chinese Journal of Hand Surgery
基金
国家临床重点专科基金[国卫办医函（2013）544]
关键词
外科皮瓣
上肢
旋髂浅动脉穿支皮瓣
修复
Surgical flaps
Upper extremity
Superficial circumflex iliac artery perforator flap
Repair
