摘要
目的 探讨腹壁下动脉穿支(deep inferior epigastric perforator,DIEP)皮瓣修复膝关节大面积软组织缺损的疗效。方法 2017年6月—2018年12月,收治15例膝关节大面积软组织缺损患者。男9例,女6例;年龄23~51岁,中位年龄36岁。缺损原因:交通事故伤7例,肿瘤5例,烧烫伤3例。创面部位:左膝8例,右膝7例。软组织缺损范围为15 cm×10 cm~30 cm×20 cm,均合并血管、神经及肌腱等组织外露。根据缺损范围制备携带1~2条血管蒂的横向DIEP皮瓣,其中单蒂皮瓣6例、双蒂联体皮瓣9例;根据缺损深度,10例皮瓣行显微镜下削薄。皮瓣切取范围16 cm×10 cm~32 cm×20 cm;厚度0.8~1.8 cm,平均1.5 cm;血管蒂长度5.0~9.0 cm,平均7.5 cm。腹部供区均直接拉拢缝合。结果 术后1例单蒂皮瓣出现远端坏死,经二期植皮修复后愈合;其余皮瓣全部成活,供受区创面均Ⅰ期愈合。患者均获随访,随访时间16~28个月,平均24个月。皮瓣外形满意,质地柔软,未出现异常毛发生长及明显色素沉着。供区仅遗留线性瘢痕,未出现腹疝等并发症。膝关节功能重建满意,肿瘤未见复发,瘢痕挛缩解除;末次随访时膝关节学会评分系统(KSS)评分达优13例、良2例。结论 DIEP皮瓣供区隐蔽,制备简便,设计灵活,可切取面积大,并发症少,是修复膝关节大面积软组织缺损的理想皮瓣之一。
Objective To investigate the effectiveness of the deep inferior epigastric perforator(DIEP) flap for extreme defects around the knee.Methods Between June 2017 and December 2018,15 patients with the extreme defects around the knee were admitted.There were 9 males and 6 females with a median age of 36 years(range,23-51 years).The etiology was the traffic accident in 7 cases,tumor in 5 cases,and burn in 3 cases.The injured location was left knee in8 cases and right knee in 7 cases.The size of soft tissue defects ranged from 15 cm×10 cm to 30 cm×20 cm,and all defects complicated with exposure of blood vessels,nerves,tendons,and other tissues.Transverse DIEP flaps with 1-2 vascular pedicles were prepared according to the size of the defect,including 6 cases of single-pedicle flaps and 9 cases of doublepedicle conjoined flaps.According to the depth of the defect,10 cases of skin flaps were thinned under microscope.The size of the DIEP flaps ranged from 16 cm×10 cm to 32 cm×20 cm;the average thickness was 1.5 cm(range,0.8-1.8 cm);the average pedicle length was 7.5 cm(range,5.0-9.0 cm).The donor site was directly sutured.Results One singlepedicle flap developed distal necrosis after operation,and healed after skin grafting;the other skin flaps survived,and the wounds at the donor and recipient sites healed by first intention.All patients were followed up 16-28 months(mean,24 months).The shape and texture of the flap were satisfactory,and there was no abnormal hair growth or obvious pigmentation.There was only linear scar at the donor site and no complication such as abdominal hernia.The appearance and function of the knee were satisfactory.No recurred tumor was observed,and the scar contracture was released.At last follow-up,13 cases were excellent and 2 cases were good,according to the Knee Society Score(KSS) criteria.Conclusion The DIEP flap is an ideal alternative for repairing the extreme defects around knee,with a concealed donor site,easy dissection,flexible design,as well as less complication.
作者
周鑫
唐林
刘安铭
陈孝均
王韶亮
邹永根
ZHOU Xin;TANG Lin;LIU Anming;CHEN Xiaojun;WANG Shaoliang;ZOU Yonggen(Department of Hand Surgery,the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,Luzhou Sichuan,646000,P.R.China;Department of Plastic and Cosmetic Surgery,the Second Affiliated Hospital of Army Military Medical University,Chongqing,400037,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2022年第7期840-844,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
腹壁下动脉穿支皮瓣
膝关节
软组织缺损
修复重建
Deep inferior epigastric perforator flap
knee
soft tissue defect
repair and reconstruction
