摘要
目的探讨桡侧副动脉穿支螺旋桨皮瓣修复肘部及上臂皮肤软组织缺损的临床效果。方法2016年10月至2019年12月,中国医学科学院整形外科医院瘢痕综合治疗中心共收治6例肘关节周围和上臂皮肤软组织缺损患者,均为女性,年龄5~66岁,平均31岁。均采用桡侧副动脉穿支螺旋桨皮瓣予以修复。术前应用便携式多普勒超声血流探测仪对桡侧副动脉后支的穿支血管进行定位,根据上肢皮肤软组织缺损的大小、形状和位置,以选定的穿支血管为蒂,以穿支穿出点为旋转点,设计、切取螺旋桨皮瓣。将皮瓣旋转一定角度后转移至受区,大桨用于修复缺损,小桨用于辅助关闭供区。剩余供区直接拉拢缝合或应用皮片游离移植修复。应用毛细血管充盈试验或吲哚菁绿SPY荧光成像系统评估即刻皮瓣血运情况。观察患者术后修复效果。结果6例患者缺损面积6.0 cm×3.0 cm^10.0 cm×7.0 cm,皮瓣面积为6.0 cm×3.5 cm^20.0 cm×8.0 cm,穿支血管蒂长度2.5~5.0 cm,平均3.6 cm,均为肌间隔穿支。皮瓣旋转100°1例,180°5例。供区直接缝合5例,应用皮片移植修复供区缺损1例。术后5例皮瓣全部存活;1例皮瓣远端出现伤口感染,清创换药后二期愈合。术后随访3个月至3年,平均2.4年,皮瓣外观及质地良好,肘关节活动度良好,所有患者对手术效果满意,肿瘤患者未见肿瘤复发。结论对于中等大小的肘部及上臂皮肤软组织缺损,桡侧副动脉穿支螺旋桨皮瓣是一种可以考虑的治疗方法。
Objective To explore the indications and technical tips of defect reconstruction in the elbow and upper arm using the radial collateral artery perforator(RCAP)propeller flap.Methods From October 2016 to December 2019,6 patients underwent defect reconstruction using the RCAP propeller flaps.All patients were female,aged from 5 to 66 years,with an average of 31 years.All of the defects were repaired with radial collateral artery perforator propeller flap.Before the surgery,the RCAP was thoroughly explored using the hand-held ultrasound Doppler and marked on the skin.According to the size,shape and location of the defect,a RCAP propeller flap was elevated based on the chosen RCAP,rotated in a certain degree with the perforating point as the rotation point.The large paddle was used to repair the defect of the upper extremity,and the small paddle was used to assist in closing the donor site.The donor sites were sutured directly or repaired with free skin graft.Capillary filling test or indocyanine green SPY fluorescence imaging system was used to evaluate the blood supply of the flap immediately.The effect was observed.Results The defect size ranged from 6.0 cm×3.0 cm to 10.0 cm×7.0 cm.The flap size ranged from 6.0 cm×3.5 cm to 20.0 cm×8.0 cm.All perforators were septocutaneous perforators.The pedicle of the pedicle ranged from 2.5 cm to 5.0 cm and the mean length was 3.6 cm.The flaps were rotated 180°in 5 patients,and 150°in one patient.The donor sites were sutured directly in 5 patients and repaired with free skin graft in one patient.Five flaps survived completely without any major complications.Wound infection occurred in one flap,which healed after debridement.All donor sites were closed primarily,except one which was covered by free skin grafting.All patients were followed up for 3 months to 3 years and the average follow-up time was 2.4 years.The appearance and texture of the flap were good,and the motion of elbow joint was normal.All patients were satisfied with the functional and aesthetic outcomes of the upper extremities.Tumor recurrence was not noticed in the oncologic patients.Conclusions For selected patients,the RCAP propeller flap could be an alternative option for soft-tissue defect reconstruction in the upper extremity.
作者
李杉珊
朱珊
臧梦青
陈博
韩婷璐
谢婷珺
岳帅
王丹莹
刘元波
Li Shanshan;Zhu Shan;Zang Mengqing;Chen Bo;Han Tinglu;Xie Tingjun;Yue Shuai;Wang Danying;Liu Yuanbo(Department of Plastic and Reconstructive Surgery,Plastic Surgery Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100144,China)
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2020年第9期984-989,共6页
Chinese Journal of Plastic Surgery
基金
北京协和医学院"中央高校基本科研业务费"项目(2091018027)。
关键词
穿支皮瓣
修复
肘
臂
螺旋桨皮瓣
Perforator flap
Reconstructive surgical procedures
Elbow,arm
Propeller flaps
