摘要
目的利用多种形式的游离旋髂浅动脉穿支皮瓣(SCIAPF)修复软组织缺损,总结临床疗效,并评价SCIAPF的临床新价值。方法回顾性分析2015年1月-2019年5月在温州医科大学附属第二医院骨科收治的42例组织缺损患者,其中足部9例,踝部8例,小腿8例,前臂7例,手部9例,口腔1例;均采用SCIAPF修复,单一软组织缺损创面28例,多个软组织缺损创面8例,多种组织复合缺损6例。创面面积1.2 cm×1.8 cm~14.0 cm×20.8 cm,皮瓣面积1.5 cm×2.0 cm~15.3 cm×22.3 cm。术后采用复诊、电话等方式进行随访,观察皮瓣成活情况和并发症。结果本组42例中,单一皮瓣共28例,其中旋髂浅动脉浅支皮瓣18例,旋髂浅动脉深支皮瓣2例,浅支加深支皮瓣8例;嵌合瓣6例,其中旋髂浅动脉浅支皮瓣加深支髂骨瓣4例,旋髂浅动脉皮瓣加缝匠肌肌瓣2例;分叶瓣8例。动脉吻合方式:端侧吻合35例,端端吻合7例;静脉吻合:与旋髂浅静脉吻合25例,与伴行静脉吻合12例,二者均吻合5例,其中静脉端端吻合27例,端侧吻合15例。所有皮瓣供区均一期直接缝合。本组皮瓣全部成活,其中1例出现动脉端侧吻合口破裂出血,重新吻合后成活;皮瓣和供区创面均一期愈合。随访6~24(平均11.5)个月,SCIAPF色泽红润,质地柔软,未见明显臃肿,皮瓣耐磨,未见色素沉着;腹股沟供区愈合良好,35例遗留线形瘢痕,7例轻度瘢痕增生,供区侧髋关节主、被动屈、伸活动正常;3例因股外侧皮神经损伤出现大腿麻木,术后3个月后完全消失。结论基于旋髂浅动脉系统的浅、深支的各种组织瓣,通过"分叶"和"嵌合"的新应用,能满足临床上大部分修复需求。
ObjectiveVerstaile free superficial circumflex iliac artery perforator flap(SCIAPF)were adopted for various reconstructive scenarios,and its clinical effect and value was evaluated.MethodsRetrospective analysis was performed on 42 patients with tissue defects admitted in the Department of Orthopeadic of the Second Affiliated Hospital of Wenzhou Medical University from January 2015 to May 2019.Nine patients had injury in the foot,8 in ankle,8 in calf,7 in forearm,9 in hand,and 1 in the mouth.All of the defects were repaired by SCIAPF,including 28 single soft tissue defect wounds,8 multiple soft tissue defect,and 6 composite defects.The size of soft tissue defect were 1.2 cm×1.8 cm-14.0 cm×20.8 cm.The size of flaps were 1.5 cm×2.0 cm-15.3 cm×22.3 cm.The patients entered follow up by outpatient clinic visit and telephone reviews to observe the survival of the flaps,functional recovery and complications.ResultsIn this series,there were 28 flaps,including 18 pedicled with superficia branch of superficial circumflex iliac artery,2 pedicled with deep branch of superficial circumflex iliac artery,and 8 pedicled with 2 branches.Six were chimeric flaps.Among them,4 flaps were iliac bone flaps with superficial branch of superficial circumflex iliac artery flaps,and 2 were superficial iliac circumflex artery flap with sartorius muscle flap.Eight cases were resurfaced with lobulated SCIAPF.Arterial anastomoses:end-to-side in 35 arteries and end-to-end in 7 arteries.Venous anastomosis:end-to-end in 27 veins and end-to-side in 15 veins.Venous return through superficial iliac circumflex vein in 25 flaps,through venae comitantes in 12 flaps and through both in 5 flaps.All flap donor sites were sutured directly.All flaps survived uneventfully except for one that compromised with end-to-side anastomotic dehiscence and bleeding,and survived after re-anastomosis.All flaps and donor sites healed primarily.During the follow-up of 6-24(mean,11.5)months,the pliable flaps were ruddy in colour and soft in texture,without obvious bloatness and pigmentation.The donor site healed well with linear scars in 35 cases and mild scar hyperplasia in 7 cases.The donor hip function were normal.Three patients suffered a numbness of the thigh caused by intraoperative injury lateral femoral cutaneous nerve and it disappeared completely after 3 months.ConclusionNew applications of lobulated or chimeric SCIAPF,based on the SCIA vasculature or its branches,can meet most of the clinical repair requirement.
作者
褚庭纲
陶振宇
周锡杰
高伟阳
陈星隆
CHU Tinggang;TAO Zhenyu;ZHOU Xijie;GAO Weiyang;CHEN Xinglong(Department of Orthopeadics,The Second Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang Province 325027,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2023年第2期179-184,共6页
Chinese Journal of Microsurgery
基金
温州市科学技术协会项目(KJFW60)。
关键词
旋髂浅动脉穿支皮瓣
分叶皮瓣
嵌合皮瓣
供区
软组织缺损
修复
Superficial circumflex iliac artery perforator flap
Lobulated flap
Chimeric flap
Donor site
Soft tissue defect
Repair
作者简介
通讯作者:陈星隆,Email:drchenxinglong@126.com,电话:+8613806894472。
