携带穿支血管推进皮瓣在肢体软组织缺损创面修复中的应用

doi:10.3760/cma.j.cn101202-20200118-00013

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摘要目的探讨应用创面邻近知名血管穿支推进皮瓣修复软组织缺损的临床应用。方法回顾性研究。纳入2015年7月—2017年12月解放军东部战区总医院秦淮医疗区骨科应用创面邻近知名血管穿支推进皮瓣修复软组织缺损26例,其中男19例、女7例,年龄7~68岁。腕部缺损3例、手背皮瓣供区缺损4例、指端缺损9例、踝部缺损5例、小腿缺损5例;腕部创面大小为2.0 cm×2.5 cm~2.5 cm×4.0 cm,手背创面大小为1.2 cm×1.6 cm~1.4 cm×2.0 cm,指端创面大小为0.8 cm×1.2 cm~1.0 cm×1.3 cm,小腿及踝部创面大小为2.5 cm×3.0 cm~3.5 cm×5 cm。术前应用多普勒探测穿支血管,以穿支血管为中心设计推进皮瓣。术中分别以桡动脉、掌背动脉、指动脉、胫后动脉、胫前动脉、腓动脉等知名血管穿支为皮瓣之血管蒂,于一侧切开皮瓣,找出穿支血管,然后找出主干血管,应用会师法切取皮瓣,游离后将皮瓣向前推移覆盖创面。25例患者皮瓣供区直接缝合;1例踝部缺损患者供区创面约2 cm×2 cm,行皮片移植修复。结果 26例皮瓣均存活,其中25例皮瓣于术后第14天拆线,创口一级愈合;另1例小腿推进皮瓣远端边角约0.5 cm×1 cm术后出现坏死,经换药后痂下愈合。术后随访1~3年,皮瓣无臃肿,外观满意,质地良好,与周围皮肤质地相近,周围关节活动无受限,手部皮瓣两点辨别觉6~8 mm,腕部及下肢皮瓣感觉恢复S₃~S₅,供区远端皮肤感觉S₄~S₅。结论采用创面邻近知名血管穿支推进皮瓣修复肢体小面积软组织缺损,具有手术操作简便、皮瓣存活率高、外观良好、与周围皮肤质地相近,感觉功能恢复良好等优点,建议临床推广应用。

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	郑晓飞
	江起庭
	胡小峰
	刘国印
	陈建民

关键词 ：外科皮瓣, 穿支皮瓣, 组织缺损, 创面修复。

Key words： Surgical flaps Perforators flap Tissue defect Wound repair.

收稿日期: 2020-01-18

基金资助:江苏省自然科学基金(BK20181113);南京市科技计划(201803059)

通讯作者: 胡小峰,Email: 274072319@qq.com

引用本文:

郑晓飞, 江起庭, 胡小峰, 刘国印, 陈建民. 携带穿支血管推进皮瓣在肢体软组织缺损创面修复中的应用[J]. 中华解剖与临床杂志, 2020, 25(6): 695-697.
Zheng Xiaofei, Jiang Qiting, Hu Xiaofeng, Liu Guoyin, Chen Jianmin. Clinical application of advancement flap with major artery for repairing wounds in limbs. Chinese Journal of Anatomy and Clinics, 2020, 25(6): 695-697.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20200118-00013 或 http://www.cjac.com.cn/CN/Y2020/V25/I6/695

[1]	Blondeel PN, Van Landuyt KH, Monstrey SJ, et al.The “Gent” consensus on perforator flap terminology: preliminary definitions[J]. Plast Reconstr Surg, 2003, 112(5): 1378-1387. DOI:10.1097/01.PRS.0000081071.83805.B6.
[2]	唐举玉, 魏在荣, 张世民, 等. 穿支皮瓣的临床应用原则专家共识[J]. 中华显微外科杂志, 2016, 39(2): 105-106. DOI:10.3760/cma.j.issn.1001-2036.2016.02.001.Tang JY, Wei ZZ, Zhang SM, et al.The clinical application principle of perforator flap is agreed by experts[J]. Chin J Microsurg, 2016, 39(2): 105-106. DOI:10.3760/cma.j.issn.1001-2036.2016.02.001.
[3]	王海峰, 李小河, 李世元, 等. 旋股外侧动脉降支-膝上外侧动脉穿支逆行股前外侧皮瓣的临床应用[J]. 中华解剖与临床杂志, 2017, 22(6): 515-518. DOI:10.3760/cma.j.issn.2095-7041.2017.06.014.Wang HF, Li XH, Li SY, et al.Clinical application of the reversed anterolateral thigh flap pedicled with the descending branch of lateral circumflex femoral artery-lateral superior genicular artery perforator[J]. Chin J Anat Clin, 2017, 22(6): 515-518. DOI:10.3760/cma.j.issn.2095-7041.2017.06.014.
[4]	郑晓飞, 李建美, 刘国印, 等. 旋股外侧动脉降支串联分叶皮瓣的临床应用[J]. 中华手外科杂志, 2016, 32(6): 470-471. DOI:10.3760/cma.j.issn.1005-054X.2016.06.032.Zheng XF, Li JM, Liu GY, et al.Clinical application of splitter flap with descending branch of lateral femoral artery in tandem[J]. Chin J Hand Surg, 2016, 32(6): 470-471. DOI:10.3760/cma.j.issn.1005-054X.2016.06.032.
[5]	周晓, 薛明宇, 张雁, 等. 近创面穿支蒂V-Y推进皮瓣修复六种常用皮瓣供区缺损[J]. 中华整形外科杂志, 2017, 33(5): 328-334. DOI:10.3760/cma.j.issn.1009-4598.2017.05.002.Zhou X, Xue MY, Zhang Y, et al.Adjacent V-Y advanced perforator flap for defect at donor site leaving by six commonly-used flaps[J]. Chin J Plastic Surg, 2017, 33(5): 328-334. DOI:10.3760/cma.j.issn.1009-4598.2017.05.002.
[6]	李攀登, 沈国良. 胫后动脉穿支为蒂的V-Y推进皮瓣修复胫前区骨外露较小创面22例[J]. 中华烧伤杂志, 2017, 33(7): 448-450. DOI:10.3760/cma.j.issn.1009-2587.2017.07.013.Li PD, Shen GL.V-Y advanced perforator flap pedicled with posterior tibial artery perforator was used to repair the small bone exposure in anterior tibial region in 22 cases[J]. Chin J Burns, 2017, 33(7): 448-450. DOI:10.3760/cma.j.issn.1009-2587.2017.07.013.
[7]	王云锋, 杨敏, 张文正, 等. 指背V-Y推进皮瓣修复手指近节侧方岛状皮瓣供区32例[J]. 中华显微外科杂志, 2018, 41(3): 275-277. DOI:10.3760/cma.j.issn.1001-2036.2018.02.021.Wang YF, Yang M, Zhang WZ, et al.Repair of donor area of proximal lateral island flap with V-Y advancement flap from dorsal finger in 32 cases[J]. Chin J Microsurg, 2018, 41(3): 275-277. DOI:10.3760/cma.j.issn.1001-2036.2018.02.021.
[8]	李攀登, 沈国良, 张远贵, 等. 以随意穿支为蒂的V-Y推进皮瓣修复膝前区较小创面效果观察[J]. 中华烧伤杂志, 2017, 33(6): 381-383. DOI:10.3760/cma.j.issn.1009-2587.2017.06.018.Li PD, Shen GL, Zhang YG, et al.Observation on the effect of V-Y advancement flap pedicled with random perforator to repair small wound in anterior knee region[J]. Chin J Burns, 2017, 33(6): 381-383. DOI:10.3760/cma.j.issn.1009-2587.2017.06.018.
[9]	尤灵建, 郭翱, 陈忠义. 携带穿支旋转V-Y推进皮瓣对老年胫骨外露修复的临床疗效研究分析[J]. 浙江创伤外科, 2017, 22(1): 106-108. DOI:10.3969/j.issn.1009-7147.2017.01.048.You LJ, Guo X, Chen ZY.Clinical effect of rotating V-Y advancement flap with perforator on tibial exposure repair in the elderly[J]. Zhejiang Journal of Traumatic Surgery, 2017, 22(1): 106-108. DOI:10.3969/j.issn.1009-7147.2017.01.048.
[10]	周思拓, 黄覛韬, 曾纪章, 等. 携带知名血管穿支的新型V-Y推进皮瓣修复全身多处皮肤软组织缺损的疗效[J]. 中华烧伤杂志, 2017, 33(10): 611-615. DOI:10.3760/cma.j.issn.1009-2587.2017.10.005.Zhou ST, Huang MT, Zeng JZ, et al.Effects of improved V-Y advancement flap with major artery perforator on repairing skin and soft tissue defects[J]. Chin J Burns, 2017, 33(10): 611-615. DOI:10.3760/cma.j.issn.1009-2587.2017.10.005.
[11]	Xu M, Yang C, Wang WJ, et al.An “oxhorn”-shaped V-Y advancement flap unilaterally pedicled on a nasal superficial musculoaponeurotic system for nasal reconstruction[J]. J Plast Reconstr Aesthet Surg, 2015, 68(11): 1516-1521. DOI:10.1016/j.bjps.2015.07.016.