摘要
目的 探讨穿支螺旋桨皮瓣连续转移技术用于下肢远端软组织缺损修复中的可行性和疗效。方法 2015年7月—2021年7月,收治10例下肢远端软组织缺损患者。其中,男8例,女2例;年龄6-71岁,中位年龄47岁。病因:恶性肿瘤切除后遗留创面5例,外伤3例,烧伤后瘢痕挛缩1例,糖尿病足溃疡1例。创面部位:胫前区1例,小腿远端和跟腱3例,足背和外踝4例,足跟1例,足底1例。创面范围为5 cm×3 cm-8 cm×8 cm。采用大小为14 cm×4 cm-29 cm×8 cm的腓动脉穿支螺旋桨皮瓣(第1皮瓣)修复下肢远端缺损;同时,于第1皮瓣近端另切取1块穿支螺旋桨皮瓣(第2皮瓣),大小为7 cm×3 cm-19 cm×7 cm,修复第1皮瓣供区;第2皮瓣供区直接拉拢缝合。结果 手术均顺利完成,第2皮瓣切取均在1 h内完成。术后10例第1皮瓣中,8例完全成活;1例出现静脉回流不畅致皮瓣远端坏死,采用皮片移植修复继发创面;1例出现静脉回流不畅,7 d后自行缓解。第2皮瓣均完全成活,未出现血肿、感染等并发症;创面Ⅰ期愈合。10例患者均获随访,随访时间2-39个月,中位时间15.5个月。皮瓣颜色、质地和厚度与受区相似,小腿轮廓未发生明显改变。随访期间肿瘤患者未见复发,瘢痕挛缩获得矫正,糖尿病足溃疡未见破溃。患者均对修复效果满意。结论 应用穿支螺旋桨皮瓣连续转移技术可以在提高下肢穿支螺旋桨皮瓣修复能力的同时,确保一期关闭供区,从而提高修复效果。
Objective To explore the feasibility and effectiveness of perforator propeller flap sequential transfer technique in repair of soft tissue defect of distal lower extremity. Methods Between July 2015 and July 2021, 10 patients with soft tissue defect of distal lower extremity were treated with perforator propeller flap sequential transfer technique.There were 8 males and 2 females, with a median age of 47 years(range, 6-71 years). The etiologies included malignant tumor in 5 cases, trauma in 3 cases, postburn scar contracture in 1 case, and diabetic foot ulcer in 1 case. The defects were located at the pretibial area in 1 case, the distal lower extremity and Achilles tendon in 3 cases, the dorsum of foot and lateral malleolar area in 4 cases, the heel in 1 case, and the plantar foot in 1 case. The size of the defect ranged from5 cm×3 cm to 8 cm×8 cm. Peroneal artery perforator propellor flaps(the 1st flap) in size of 14 cm×4 cm to 29 cm×8 cm were used to repair the defects of distal lower extremity. The donor site defects were repaired with the other perforator propeller flaps(the 2nd flap) in size of 7 cm×3 cm to 19 cm×7 cm. The donor site of the 2nd flap was directly closed.Results All the operations were successfully completed and all of the 2nd flaps were elevated within 1 hour. Eight the 1st flaps survived completely;2 had venous congestion. Among the 2 patients with venous congestion, 1 had necrosis of the distal end of the flap, and the secondary wound was repaired by skin grafting;1 recovered spontaneously after 7 days. The2nd flaps totally survived. No complication such as hematoma or infection occurred. Primary closure was achieved in all the recipient and donor sites. All patients were followed up 2-39 months,with a median of 15.5 months. The color, texture,and thickness of the flaps matched well with those of recipient sites. The normal contour of the leg was preserved. During follow-up, no recurrence of malignance or ulcer was observed. The scar contracture was completely released. All patients were satisfied with the reconstructive outcomes. Conclusion The application of the perforator propeller flap sequential transfer technique can improve the repair ability of the lower extremity perforator propeller flap while ensuring the firststage closure of the donor site, thereby improving the effectiveness.
作者
冉小叶
刘元波
杨若梦
臧梦青
RAN Xiaoye;LIU Yuanbo;YANG Ruomeng;ZANG Mengqing(Scar Comprehensive Treatment Center,Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing,100144,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2022年第4期451-455,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
下肢远端软组织缺损
穿支皮瓣
螺旋桨皮瓣
皮瓣连续转移技术
供区修复
Soft tissue defect of distal lower extremity
perforator flap
propeller flap
flap sequential transfer technique
donor site repair
