摘要
目的探讨带腹壁下血管的脐旁穿支皮瓣在各种毁损性创面修复中的应用策略及临床效果。方法采用回顾性观察性研究方法。2015年1月—2020年12月,北京积水潭医院收治各部位毁损性创面患者28例,其中男21例、女7例,年龄25~66岁。本组患者清创后创面面积为17 cm×8 cm~35 cm×22 cm,分别采用带蒂或游离带腹壁下血管的脐旁穿支皮瓣修复,皮瓣切取面积为18 cm×10 cm~37 cm×24 cm,血管蒂长13.0~17.0(15.1±2.3)cm。对腕部Ⅲ型高压电烧伤创面,采取2种方法重建手部血流:一是应用大隐静脉桥接桡动脉,二是设计血流桥接皮瓣。供瓣区先用聚丙烯补片加强腹壁强度,再直接拉拢缝合;如不能直接拉拢缝合,先用异体脱细胞真皮基质(ADM)加强腹壁强度,再于大腿取自体中厚皮移植覆盖。观察皮瓣移植、手部血流重建与供瓣区修复情况,术后皮瓣成活情况、创面和供瓣区愈合情况,以及随访时皮瓣外观、创面和供瓣区恢复情况。结果本组患者中13例行带蒂皮瓣移植、15例行游离皮瓣移植。7例腕部Ⅲ型高压电烧伤患者采用大隐静脉桥接桡动脉重建手部血流,3例腕部Ⅲ型高压电烧伤患者采用血流桥接皮瓣重建手部血流。16例患者供瓣区用补片加强腹壁强度,然后直接拉拢缝合;12例患者供瓣区用异体ADM加强腹壁强度,再移植皮片覆盖。术后皮瓣完全成活。24例患者创面愈合;3例腕部Ⅲ型高压电烧伤患者及1例髂部慢性放射性溃疡患者因皮瓣下仍然有部分坏死组织及脓性分泌物,创面未能愈合,经再次清创及换药后愈合。随访6个月~3年,本组患者皮瓣外观良好,创面无复发,腹部供瓣区无腹壁疝发生。结论带腹壁下血管的脐旁穿支皮瓣设计灵活、血管蒂长,切取面积较大,可行带蒂或游离移植,是修复各部位毁损性创面的一种较好选择。
Objective To explore the application strategy and clinical effects of paraumbilical perforator flap with inferior epigastric vessels in repairing various destructive wounds.Methods The retrospective observational study method was applied.From January 2015 to December 2020,28 patients(21 males and 7 females,aged 25 to 66 years)with destructive wounds in various body parts were admitted to Beijing Jishuitan Hospital.The wound areas of patients ranged from 17 cm×8 cm to 35 cm×22 cm after debridement.Pedicled or free paraumbilical perforator flaps with inferior epigastric vessels were used to repair the wounds respectively.The areas of flaps were from 18 cm×10 cm to 37 cm×24 cm,and the lengths of vascular pedicles were 13.0-17.0(15.1±2.3)cm.For typeⅢhigh-voltage electric burn wounds of wrist,two methods were used to reconstruct the blood flow of hand,one is to bridge the radial artery with saphenous vein grafting and the other one is to design blood flow-through flap.The strength of abdominal wall in the donor site was strengthened by polypropylene patch,and then the wounds were directly sutured.If the wounds could not be sutured directly,then allogenic acellular dermal matrix(ADM)was applied to strengthen the abdominal wall first,and then autologous medium-thickness skin graft was taken from the thigh to cover the wounds.The flap transplantation,hand blood flow reconstruction,the repair of donor site,the flap survival,the wound and donor site healing after operation,the appearance of flaps,and the wound and donor site recovery during follow-up were observed.Results Among the patients in this group,13 patients were treated with pedicled flap grafting,while 15 patients were treated with free flap grafting.The hand blood flow of 7 patients with typeⅢhigh-voltage electric burn wounds of wrist was reconstructed by bridging radial artery with saphenous vein grafting.The hand blood flow of 3 patients with typeⅢhigh-voltage electric burn wounds of wrist was reconstructed with blood flow-through flap.In 16 patient
作者
覃凤均
沈余明
杜伟力
程琳
张颖
马春旭
Qin Fengjun;Shen Yuming;Du Weili;Cheng Lin;Zhang Ying;Ma Chunxu(Department of Burns,Beijing Jishuitan Hospital,Beijing 100035,China)
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2021年第7期606-613,共8页
Chinese Journal of Burns
基金
国家重点研发计划“变革性技术关键科学问题”重点专项(2018YFA0703104)
北京市医管局临床技术创新项目(XMLX201838)。
关键词
伤口愈合
外科皮瓣
毁损性创面
脐旁穿支皮瓣
补片
Wound healing
Surgical flaps
Destructive wounds
Paraumbilical perforator flap
Patch
