摘要
目的探讨带肌瓣的嵌合穿支皮瓣修复合并深部死腔难愈性创面的临床效果。方法2015年2月至2019年2月,中国人民解放军联勤保障部队第九四○医院全军烧伤整形外科中心收治22例合并有深部死腔的难愈性创面患者,男17例,女5例,年龄17~72岁,平均36.4岁。6例位于足底,6例位于小腿及踝关节,5例位于会阴部,2例位于肘部,2例位于背部,1例位于眼眶处。缺损创面:5 cm×4 cm^16 cm×11 cm,死腔范围:3 cm×2 cm^10 cm×4 cm。14例采用股前外侧嵌合穿支皮瓣游离移植修复,5例采用股前外侧嵌合穿支皮瓣带蒂修复,1例采用腓动脉嵌合穿支皮瓣带蒂修复,1例采用腓浅动脉嵌合穿支皮瓣带蒂修复,1例采用胫后动脉嵌合穿支皮瓣带蒂修复。术后对创面和功能进行随访。结果本组22例,皮瓣面积为6 cm×5 cm^17 cm×12 cm,肌瓣面积为3 cm×2 cm^10 cm×4 cm。1例腓浅动脉穿支嵌合皮瓣术后皮瓣边缘拆线后裂开形成创面,经换药后二期手术植皮愈合;1例股前外侧嵌合穿支皮瓣术后出现皮下窦道,换药清创后创面愈合;其余20例嵌合穿支皮瓣均成活良好。随访3~18个月,创面外形、功能均恢复满意。结论带肌瓣的嵌合穿支皮瓣中肌瓣填充死腔,皮瓣覆盖创面,可同时修复深部死腔和体表创面,是修复合并深部死腔的难愈性创面的良好方法。
Objective To investigate the clinical effect of using chimeric perforator flap with muscle flap in repairing deep dead space of refractory wound.Methods From February 2015 to February 2019,22 cases of refractory wounds with deep dead space were admitted to the Burn and Plastic Surgery Center of the 940th Hospital of the Joint Logistic Support Force of the PLA,including 17 males and 5 females,aged from 17 to 72 years old,with an average age of 36.4 years old.6 cases were located in the plantar,6 in the calf and ankle joints,5 in the perineum,2 in the elbow,2 in the back and 1 in the orbit.Defect area ranged from 5 cm×4 cm to 16 cm×11 cm.Dead space ranged from 3 cm×2 cm to 10 cm×4 cm.14 cases were repaired with free transplantation of anterolateral femoral chimeric perforator flap,5 cases with anterolateral femoral chimeric perforator flap,1 case with peroneal artery chimeric perforator flap,1 case with superficial peroneal artery chimeric perforator flap,and 1 case with posterior tibial artery chimeric perforator flap.Results In the 22 cases of this group,the flap area ranged from 6 cm×5 cm to 17 cm×12 cm,and the muscle flap area ranged from 3 cm×2 cm to 10 cm×4 cm.One case of refractory wound repaired by superficial peroneal artery perforator chimeric flap was poorly healed in the margin of the flap,which was healed by skin grafting in the second stage after dressing change.One case of refractory wound repaired by anterolateral femoral chimeric perforator flap presented subcutaneous sinus after surgery.The wound was healed after dressing change and debridement.All the other 20 cases survived well.The patients were followed up for 3-18 months,and the appearance and function of the wound were recovered satisfactorily.Conclusions In the chimeric perforator flap with muscle flap,the muscle flap filled up the dead space and the flap covered the wound on body surface at the same time,which is one of the good methods to repair the refractory wound with deep dead space.
作者
陈黎明
刘毅
张诚
张鲜英
廉娟
Chen Liming;Liu Yi;Zhang Cheng;Zhang Xianying;Lian Juan(Burn and Plastic Surgery Center,the 940th Hospital of the Joint Logistic Support Force of PLA,Lanzhou 730050,China)
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2020年第3期279-283,共5页
Chinese Journal of Plastic Surgery
关键词
穿支皮瓣
外科皮瓣
修复外科手术
伤口愈合
Perforator flap
Surgical flaps
Reconstructive surgical procedures
Wound healing
