摘要
目的探讨采用腹壁下动脉脐旁穿支和肋间后动脉外侧皮穿支双血供来源的胸脐联体穿支皮瓣修复前臂大面积皮肤软组织缺损的手术方法及临床疗效．方法自2006年1月至2016年1月．对14例前臂大面积皮肤缺损患者，急诊采用近端以腹壁下动脉脐旁穿支为血供、远端以肋间后动脉皮穿支为血供的超长皮瓣游离移植修复．皮瓣长25，43cm，平均36cm．宽5～14cm，平均9cm。所有患者均定期随访，随访内容包括外观、手功能和供区愈合情况。结果术后12例皮瓣顺利成活：1例皮瓣术后28h出现动脉危象．经保守治疗1h后皮瓣血供无改善。经再次手术探查证实皮瓣近端吻合口栓塞，去栓后重新吻合动脉后皮瓣成活：1例皮瓣术后40h出现静脉危象，给予皮瓣边缘拆除缝线、通畅引流、皮瓣表面小切口放血5d后，静脉危象缓解，皮瓣成活；伤口均一期愈合，胸腹部供区伤口一期愈合。随访时间为8～72个月，平均31个月。皮瓣无明显臃肿．皮瓣质地接近前臂皮肤，无明显色素沉着，皮瓣与周围正常皮肤过渡自然，均恢复保护性感觉，未出现破溃、感染等并发症。2例腹部供区植皮者植皮愈合满意，未出现植皮挛缩，其余12例供区直接缝合者腹部遗留线状瘢痕，边缘柔软．无明显挛缩。结论采用双血供来源的超长胸脐联体穿支皮瓣修复前臂大面积皮肤软组织缺损伤，皮瓣的切取长度明显延长．皮瓣远端血供也得到了保证，可以获得较为满意的临床效果。
Objective To explore the surgical method and clinical effect of repairing the large area skin de- fect of forearm with the perforator flap pedicle with the inferior epigastric artery perforator and the lateral cutaneous branch of the posterior intercostal artery. Methods From January, 2006 to January, 2016, 14 cases of forearm large area of skin defects were treated with the overlength flap at one stage. The proximal flap to the inferior epigastric artery umbilical perforation and the flap distal to the posterior interphalangeal artery perforation were used for the blood supply of superficial flap. The length of the flap was 25-43 cm（average, 36 cm）. The width of the flap was 5-14 cm （average, 9 cm）. All patients were followed-up regularly. The content of the follow-up included three aspects： ap- pearance, hand function and the recovery of the donor site. Results Twelve cases of postoperative flaps success- fully survived. Arterial crisis was seen in 1 flap 28 hours after surgery. The re-surgical exploration was adopted after conservation treatment for 1 h without remission and the proximal anastomotic flap embolization was confirmed. The flap survived. Venous crisis was seen in 1 case. The flap survived with the help of removing the suture, smoothing drainage and bleeding for 5 d. The wounds and the donor site of the thoracic and abdominal region healed at the first stage. The follow-up time was 8-72 months, with an average of 31 months. The flaps had no obvious bloated, the skin texture was close to forearm skin and the flaps were restored protected sensation. There was no ulceration, infection and other complications. The healing of skin graft was satisfactory in 2 cases in abdominal donor site. No skin graft contracture occurred. The remaining 12 cases had linear scar in the abdomen of the donor site. The edge of the scar was soft and no obvious contracture occurred. Conclusion Super long thoracic umbilical conjoined perforator flap can re- pair the lager area skin defect of forearm with double bloo
作者
巨积辉
李雷
徐磊
蒋国栋
侯瑞兴
Ju Jihui;Li Lei;Xu Lei;Jiang Guodong;Hou Ruixing(Department of Hand Surgery, Ruihua Affiliated Hospital of Sooc how University, Suzhou, Jiangsu 215104, China)
出处
《中华显微外科杂志》
CSCD
北大核心
2018年第2期137-141,共5页
Chinese Journal of Microsurgery
基金
江苏省自然科学基金（BK20151203）
江苏省“333高层次人才培养工程”资金资助项目（BRA2017068）
关键词
联体皮瓣
穿支皮瓣
腹壁下动脉
肋间后动脉
前臂
缺损
Conjoined flap,perforator flap
lnferior epigastric ariery
Posterior intercostal artery
Foreartn
Defeets
