摘要
目的探讨应用显微修薄腓动脉穿支皮瓣修复手部皮肤缺损的手术方法及临床疗效。方法2011年4月-2017年4月,应用显微修薄的腓动脉穿支皮瓣修复手部皮肤缺损16例,缺损面积:2.8 cm×4.2 cm^3.2 cm×5.8 cm。在同侧小腿中上段外侧缘,设计以腓动脉穿支为血管蒂的皮瓣,在显微镜下将皮瓣内皮下脂肪组织修除后游离移植修复手部皮肤缺损创面,皮瓣切取范围:3.0 cm×4.5 cm^3.5 cm×6.2 cm,皮瓣供区均直接缝合。结果术后15例皮瓣完全成活。发生血管危象3例,均为静脉危象。2例经手术探查后成活,1例术后第4天因创面感染出现静脉危象,行小切口放血治疗3 d后皮瓣坏死。术后随访7~22个月,平均15个月。皮瓣外形、弹性、质地、色泽满意。结论应用显微修薄的腓动脉穿支皮瓣修复手部皮肤缺损可获得较好的外形,手术操作方便,皮瓣供区副损伤小,疗效肯定。
Objective To explore the surgical method and clinical effect of repairing the skin defect of hand with the microsurgically thinned peroneal perforator flap.Methods From April 2011 to April 2017,16 cases of hand skin defect were repaired by one-stage microsurgically thinned peroneal perforator flap.The area of skin defect of hand was 2.8 cm×4.2 cm to 3.2 cm×5.8 cm.At the lateral edge of the middle and upper segment of the same leg,a flap pedicled with the perforating branch of the peroneal artery was designed.The subcutaneous adipose tissue of the flap was repaired under the microscope at the first stage,and then the skin defect of the hand was repaired by free transplantation.The flap was cut from 3.0 cm×4.5 cm to 3.5 cm×6.2 cm,and the donor area of the flap was directly sutured.Results Fifteen flaps survived completely.There were 3 cases of vascular crisis,all of them were venous crisis.2 cases survived after operation exploration,1 case developed vein crisis due to wound infection on the fourth day after operation,and the flap necrosis was treated by small incision bleeding for three days.Postoperative follow-up ranged from 7 to 22 months,with an average of 15 months.The shape,elasticity,texture and color of the flap were satisfactory.Conclusion The application of one-stage microsurgically thinned peroneal perforator flap to repair hand skin defect can obtain a better shape,convenient operation,small side injury of flap donor area,and the curative effect is positive.
作者
葛华平
苗平
王瑞
胡晓美
孙莹
GE Huaping;MIAO Ping;WANG Rui(Department of Hand Microsurgery,Tianjin Rehabilitation and Recuperation Center,People's Liberation Army,Tianjin,300381,China)
出处
《实用手外科杂志》
2020年第4期402-404,共3页
Journal of Practical Hand Surgery
关键词
手损伤
显微外科
皮瓣
修复
Hand injury
Microsurgery
Flap
Repair
