胸背动脉穿支皮瓣修复乳房缺损畸形的临床应用

目的探讨胸背动脉穿支皮瓣或预扩张后胸背动脉穿支皮瓣,在乳房缺损畸形重建中的临床应用。方法2007年8月至2014年4月,对23例乳房缺损畸形患者,采用预扩张带蒂胸背动脉穿支皮瓣修复5例,单纯带蒂胸背动脉穿支皮瓣修复18例,皮瓣大小为12 cm×22 cm~7 cm×12 cm。结果 23例患者术后皮瓣均完全成活,供区无血肿、血清肿等并发症发生。术后随访3~26个月,皮瓣成活良好,外形恢复较好。结论胸背动脉穿支皮瓣较薄,穿支血管蒂较长且走行恒定,预扩张后可提供较大面积的皮瓣,是修复乳房浅表组织缺损畸形的良好选择。     

不带背阔肌的胸背动脉穿支皮瓣的临床应用

目的 探讨不带背阔肌的胸背动脉穿支皮瓣在临床中的应用.方法 术前常规用多普勒超声探测仪探测穿支点并标记,均选择第1穿支.设计将穿支点包括在内的不带背阔肌的带蒂或胸背动脉穿支游离皮瓣修复四肢或腋窝创面.结果 2006年8月至2007年4月,于临床应用7例.皮瓣大小为6 cm×9 cm～12 cm×16 cm.术后皮瓣均完全成活,供区无血肿、血清肿等并发症发生,供区外形与对侧基本对称.结论 胸背动脉穿支皮瓣保留了背阔肌,皮瓣较薄,血运可靠,能明显降低对供区的损伤,是修复创面的一种良好选择.     

邻位组织瓣在乳腺癌保乳手术的乳房缺损修复中的应用现状

目的阐述邻位组织瓣在乳腺癌保乳手术的乳房缺损修复中的应用现状。方法检索近5年来的相关文献,对有关乳腺癌保乳手术中乳房缺损的修复方法、邻位组织瓣的分类、适应证以及优缺点进行归纳总结。结果目前乳腺癌保乳术后乳房缺损修复的方法有多种,对缺损量较大的患者采用邻位组织瓣进行修复是获得较好美容效果的有效方法。常用的邻位组织瓣包括:腋侧胸背部脂肪筋膜瓣、保留背阔肌的胸背动脉穿支皮瓣、乳房下皱襞腹直肌前鞘上方脂肪筋膜瓣、肋间动脉穿支脂肪筋膜瓣、带内乳动脉蒂筋膜岛状皮瓣等。结论采用乳房邻位组织瓣替代技术进行乳腺癌保乳手术后的缺损修复治疗是一种安全、有效且相对简单的一种技术,术后患者对乳房外形及整体美容效果满意度高。     

胸背动脉穿支皮瓣移植修复不同部位皮肤软组织缺损16例

目的 探讨胸背动脉穿支皮瓣游离移植和带蒂转移修复四肢及颈部、腋窝、肩背部皮肤软组织缺损的可行性和临床效果.方法 选用同侧带血管蒂胸背动脉穿支皮瓣修复5例颈部、腋窝、肩背部创面;选用胸背动脉穿支皮瓣游离移植修复11例四肢骨外露或肌腱外露创面.其中12例以胸背动静脉-外侧支-穿支为血管蒂,4例以胸背动静脉-前锯肌支-穿支为血管蒂,皮瓣不携带深筋膜、背阔肌和胸背神经.皮瓣面积最小10 cm×5 cm,最大26 cm×10 cm.结果 术后16例皮瓣全部成活,供区与受区创面一期愈合.术后随访3～ 24个月,皮瓣质地良好、外形不臃肿,皮瓣供区瘢痕不明显,肩关节功能无影响.结论 胸背动脉穿支皮瓣质地良好、供区隐蔽、血管蒂长、血供可靠,且不牺牲背阔肌和胸背神经.带蒂转移是修复同侧颈、肩、腋窝皮肤软组织缺损的理想方法,游离移植适合修复四肢皮肤软组织缺损.     

携带少量肌袖的胸背动脉穿支皮瓣的临床应用

目的 探讨携带少量肌袖的胸背动脉穿支皮瓣修复缺损创面的手术方法及临床效果.方法 自2005年3月至2009年12月,应用携带少量肌袖的游离胸背动脉穿支皮瓣修复10例皮肤缺损患者,其中头颈部肿瘤切除术后皮肤缺损者3例,四肢部位皮肤缺损者7例.在游离皮瓣过程中,将胸背神经和大部分背阔肌留存于供区.根据创面缺损情况设计携带穿支血管处的少量背阔肌肌袖的胸背动脉穿支皮瓣,皮瓣大小为4.5 cm×7.0 cm～6.5 cm×12.0 cm.供区直接拉拢缝合.结果 术后随访10例患者2～41个月,游离移植的皮瓣成活良好,缺损修复后其外形较满意;供区余留的背阔肌其收缩功能仍存在,切口愈合良好.结论 该术式中保留的部分背阔肌肌袖,既有利于保护穿支皮瓣,又可改善皮瓣的臃肿外形;保留了胸背神经和大部分背阔肌,使供区损伤较小,符合皮瓣切取原则.     

部分背阔肌皮瓣或侧胸壁脂肪筋膜皮瓣在外侧象限乳腺癌保乳治疗中的应用

目的总结在外侧象限乳腺癌保乳术后采用部分背阔肌皮瓣或侧胸壁脂肪筋膜皮瓣重建乳房的效果。方法 2012年9月—2016年9月,收治18例外侧象限乳腺癌女性患者。年龄41~65岁,平均46.5岁。浸润性导管癌17例,黏液腺癌1例。均为单发肿物,直径2.5~4.0 cm,距离乳头乳晕3~5 cm。患者乳房体积均为中-小型。保乳术后应用部分背阔肌皮瓣(13例)或侧胸壁脂肪筋膜皮瓣(5例)重建乳房。术后均行放疗。结果术后1例出现部分侧胸壁脂肪筋膜皮瓣坏死合并感染,其余皮瓣均顺利成活。16例切口Ⅰ期愈合,2例出现血清肿,穿刺抽液及加压包扎后Ⅱ期愈合。术后患者均获随访,随访时间6~50个月,平均26.8个月。术后6个月参照Kim等标准评价乳房重建效果,优12例、良4例、一般2例。随访期间未出现局部复发及远处转移。结论外侧象限乳腺癌保乳术后应用侧胸壁手术切口联合部分背阔肌皮瓣或侧胸壁脂肪筋膜皮瓣重建乳房,可以获得满意的美容效果。     

多种皮瓣修复乳腺癌术后放疗继发前胸壁放射性溃疡的临床评价

目的 总结多种皮瓣修复乳腺癌术后放疔继发前胸壁放射性溃疡的疗效和经验.方法 自2000年1月至2008年12月,共收治乳腺癌术后放疗继发前胸肇放射性溃疡患者24例.采用下腹部横行腹直肌肌皮瓣(11例)、背阔肌肌皮瓣带蒂转移术(9例)和健侧乳房皮瓣(4例)转移修复溃疡.肌皮瓣面积为18 cm×12 cm～36 cm ×9 cm,乳房皮瓣面积为13 cm ×6 cm～16 cm×6 cm.2例患者在行背阔肌肌皮瓣转移术前行DSA检查,明确胸背动脉的位置.背阔肌肌皮瓣供区行中厚皮片移植修复,其余供瓣区直接拉拢缝合.结果 1例因下腹腹直肌肌皮瓣巨大、脂肪过于肥厚而出现尖端皮肤干性坏死和脂肪液化,其余23例皮瓣均完全成活.术后随访3～12个月,溃疡无复发.结论 背阔肌肌皮瓣是修复前胸壁放射性溃疡的首选皮瓣.术前行DSA检杳明确胸背动脉的位置,是保证手术成功的有效方法.带蒂下腹腹直肌肌皮瓣因手术难度和创伤较大,可作为次选.健侧乳房皮瓣可导致健侧乳房畸形,且供瓣区面积有限,因而尽可能避免选用.     

胸廓内动脉穿支皮瓣及背阔肌Kiss皮瓣在乳腺肿瘤切除术后胸壁缺损中的应用

目的探讨对侧胸廓内动脉穿支皮瓣及背阔肌Kiss皮瓣修复乳腺肿瘤切除术后胸壁软组织缺损的临床效果。方法回顾性分析大连医科大学附属第一医院2018年1月至2019年5月收治的6例乳腺肿瘤患者的临床资料,均为女性,年龄46~73岁,平均55.5岁,其中5例为局部晚期乳腺癌,1例为晚期乳腺癌。病程4个月至5年,中位时间20.1个月。4例患者行术前化疗。术中切除原发病灶后,局部皮肤软组织缺损范围达10 cm×15 cm^21 cm×31 cm,单独采取对侧胸廓内动脉穿支皮瓣或联合带蒂背阔肌Kiss皮瓣修复胸壁缺损,供区直接拉拢缝合,1例患者对侧乳房体积较大,同期行乳房缩小和乳房成形术。术后进行随访,观察皮瓣情况,以及肿瘤是否复发。结果6例胸廓内动脉穿支皮瓣切取范围为5 cm×12 cm^10 cm×23 cm,其中3例联合带蒂背阔肌Kiss皮瓣进行修复,两叶皮瓣每叶面积范围为5 cm×15 cm^7 cm×18 cm,6例患者皮瓣均成活,其中5例创面一期愈合,1例背部供区因张力稍大,出现皮下积液,经换药、引流后切口延期愈合。术后随访1~17个月,平均7.5个月,术区皮肤平整,皮瓣外观良好,对肩关节及腰部活动无影响,肿瘤均无局部复发,供区仅遗留线状瘢痕。结论应用对侧胸廓内动脉穿支皮瓣及背阔肌Kiss皮瓣修复乳腺肿瘤切除后巨大胸壁软组织缺损,无需血管吻合,手术简单,术后恢复快,并发症少,效果较好。     

胸背动脉前锯肌支在带蒂背阔肌肌皮瓣移植乳房再造中的补救作用

目的探讨胸背动脉前锯肌支在带蒂背阔肌肌皮瓣移植乳房再造中的补救作用。方法 2015年9月至2019年12月, 对4具新鲜成年女性尸体标本进行解剖, 观测胸背动脉前锯肌支的数量、长度、直径及来源。回顾性分析2015年3月至2019年3月湖南省肿瘤医院肿瘤整形外科收治的行乳腺癌改良根治术后应用带蒂背阔肌肌皮瓣移植即刻再造乳房的患者临床资料。在分离、切取带蒂背阔肌肌皮瓣的过程中发现患者的胸背动脉受损, 改用以胸背动脉前锯肌支为蒂制备背阔肌肌皮瓣再造乳房。术后对皮瓣成活情况、乳房外观和质地、乳腺癌有无复发以及供区情况进行随访。结果在4具(8侧) 标本中共发现11条前锯肌支, 长度为(6.3±1.8) cm, 直径为(2.4±0.4) mm, 其中7条发自胸背动脉主干, 3条发自胸背动脉垂直支, 1条发自胸背动脉水平支。临床病例共纳入6例女性单侧乳腺癌患者, 年龄29～61岁, 平均42.7岁;病程(10.7±5.4)个月(2～36个月)。行乳腺癌改良根治术后继发乳房缺损面积为14 cm×6 cm～16 cm×7 cm, 术中切取背阔肌肌皮瓣皮岛面积为13 cm×6 cm～17 cm×6 cm。...     

扩张背阔肌节段肌皮瓣治疗前胸部广泛瘢痕挛缩

目的探讨扩张背阔肌节段肌皮瓣在前胸部广泛瘢痕挛缩畸形中的应用价值。方法2010年10月至2012年10月,对8例（11侧）前胸部广泛瘢痕挛缩患者应用扩张背阔肌节段肌皮瓣进行修复。治疗分两期,Ⅰ期：术前超声定位胸背动脉外侧支肌皮穿支的体表投影,设计含有胸背动脉外侧支肌皮穿支的背阔肌前缘节段肌束的胸背部皮瓣,分离腔隙后,放置扩张器,扩张器注水4~6个月;Ⅱ期：胸部瘢痕松解、切除,乳腺组织复位,以胸背动脉主干或外侧支为蒂,背阔肌扩张节段肌皮瓣转移修复。结果所有皮瓣全部成活,供区可直接缝合。随访3~20个月,皮瓣质地柔软,色泽与胸部接近。术后患侧肩关节内收、内旋、后伸力量无明显减弱,背部无明显凹陷畸形,女性患者乳房形态满意。结论应用背阔肌节段肌皮瓣预扩张术修复前胸部广泛瘢痕挛缩畸形,是一种较为理想的治疗手段,值得推广。     

Pedicled perforator flaps in breast reconstruction: a new concept.

INTRODUCTION: Pedicled perforator flaps have not been widely described for the breast. The aim of this study is to report our clinical experience with pedicled perforator flaps in breast reconstruction. MATERIAL AND METHODS: Between May 2000 and May 2003, pedicled perforator flaps were used in 31 patients. The indications were immediate partial breast reconstruction and thoracic reconstruction for carcinomatous mastitis or tumour recurrence. Perforators were identified by Doppler preoperatively. The Doppler-located thoracodorsal artery perforator (TDAP) or another perforator such as the intercostal artery perforator (ICAP) was looked for. If the perforators had good calibers, the flaps were then based solely on these perforators. If the perforators were tiny but pulsating, the TDAP flap was harvested as a muscle-sparing latissimus dorsi type I (MS-LD I) with a small piece of muscle (4x2 cm) included to protect the perforators. If the perforators were not-pulsating, a larger segment of the LD muscle was incorporated to include the maximum of perforators (MS-LD II flap). The nerve that innervates the rest of the LD muscle was always spared. If most of the LD was included in the flap, the flap was then classified as MS-LD III. RESULTS: The mean flap dimensions were 20x8 cm. Using this algorithm, the TDAP flap was harvested in 18 cases and the ICAP flap in three cases. In addition, there were 10 MS-LD flaps with a variable amount of muscle. In addition, one parascapular flap was dissected. A successful flap transfer was achieved in all but three patients, in whom limited partial necrosis occurred. Seroma was not encountered at the donor sites of the perforator flaps (0%) compared to four (40%) after a MS-LD flap. CONCLUSION: Our results show that pedicled perforator flaps are additional options for breast surgery and that they may be used whenever an adequate perforator can be found. This technique is safe and reliable if the algorithm described is used when choosing a flap.     

Thoracodorsal artery perforator flap: a versatile alternative for various soft tissue defects

Thoracodorsal artery perforator (TDAP) flap is a relatively new member of the perforator flap family. The objective of this study is to describe the use of pedicled and free TDAP flaps for various soft tissue defects. Fifteen patients underwent soft tissue reconstruction using 16 TDAP flaps. Twelve pedicled flaps were used for axillary, breast, and shoulder regions. Four free flaps were used for cheek, popliteal, hand, and foot reconstruction. The flaps were harvested based on the perforators, which were preoperatively located at or close to a point 8 cm below the posterior axillary fold and 2 cm behind the lateral border of the latissimus dorsi muscle. Early, late, major, and minor complications were documented. In 13 of the 16 flaps, perforators from the thoracodorsal artery were found in the circle 3 cm in diameter, centered on the anatomic landmark. Three other perforators were found outside this circle. One flap loss was considered the only major complication. Minor complications occurred in 12.5% of flaps. Although the vascular anatomy can be variable, free and pedicled TDAP flap is a versatile option in soft tissue reconstruction.     

Use of the thoracodorsal artery perforator (TDAP) flap with implant in breast reconstruction

The latissimus dorsi (LD) musculocutaneous flap with implant has been widely used for breast reconstruction. This technique, which is safe and reliable, results in the sacrifice of the largest muscle in the body with high seroma incidence in the donor site. The thoracodorsal artery perforator (TDAP) flap spares the LD muscle. However, the TDAP has never been used together with implant for breast reconstruction. We present our strategies in sparing the LD muscle by using the TDAP flap with an implant beneath. The perforator was always mapped preoperatively. The TDAP flap was designed with the perforator located at the proximal part. Modifications to the flap should be done when multiple small perforators are found or when the perforator enters the subcutaneous tissue in the middle of the flap. A small segment of the muscle is included in the flap behind the perforator (LD-muscle sparing TDAP type I) to protect perforator compression by the implant. In very thin patients, a larger segment of the LD is needed to cover the implant (LD muscle-sparing TDAP type II). In both situations, the rest of the LD muscle is spared with its motor innervation. We present 4 patients who underwent a TDAP flap with implant for breast reconstruction. The flaps were transferred successfully. No seroma formation occurred. Combining a TDAP flap with an implant is feasible. Perforator mapping with correct flap design is the keystone in this technique. Reducing donor site morbidity and seroma rate are the ultimate goals of this technique. The TDAP flap should be modified to an LD muscle-sparing version in any case of unfavorable anatomic or clinical situations.     

Transverse thoracodorsal artery perforator flaps: experience with 31 free flaps.

The conventional design of free thoracodorsal artery perforator (TDAP) flaps is orientated vertically along the long axis of the latissimus dorsi muscle, i.e. along the course of the descending branch of the thoracodorsal artery. However, this method does not consider perforators derived from the transverse branch of the thoracodorsal artery, and leaves a long scar that runs perpendicular to the relaxed skin tension line. Accordingly, scar widening and hypertrophy are frequently encountered problems. From April 2004 to December 2005, 31 free TDAP flap transfers were performed in 29 patients for reconstruction of the lower extremity (16 flaps), head and neck (12 flaps), and upper extremity (three flaps). Flap long axes were laid transversely following the relaxed skin tension line and paddles were designed to include proximal perforators from both branches of the thoracodorsal artery. Flap sizes ranged from 7x5 cm to 22x12 cm with a mean thickness of 7.5mm (range 3-13 mm). Among the 40 perforators employed as pedicles, 34 were derived from the descending branch and six were from the transverse branch of the thoracodorsal artery. Except for a single case of total flap loss, the other flaps were successfully transferred. Donor scars ranged from 6 to 28 mm in width after a minimum follow-up period of 10 months. The transverse design may be preferred whilst planning free TDAP flap transfer, because the surgeon has a wider choice of perforators and the final donor scar has a less disfiguring appearance.     

腹壁下动脉穿支皮瓣在乳房再造和胸壁溃疡修复中的应用

目的　在解剖学研究基础上 ,对以腹壁下动静脉为蒂的横行腹直肌 (TRAM)肌皮瓣的切取进行完善和改进 ,将其精确为腹壁下动脉穿支 (DIEP)皮瓣 ,从而提供一种更为理想的乳腺癌术后乳房再造和胸壁创面修复的皮瓣。　方法切取DIEP皮瓣 ,移植至胸壁受区 ,腹壁下动静脉分别与胸廓内动静脉相吻合 ,用于乳腺癌术后乳房再造和胸壁放射性溃疡的修复。　结果　解剖学研究和临床观察发现自腹壁下动脉有粗大的肌皮穿支或皮支自血管主干发出 ,穿过腹直肌纤维直接进入皮瓣 ,因此 ,术中只剪开腹直肌前鞘 ,钝性分离腹壁下动静脉及其穿支周围的腹直肌纤维 ,无须离断腹直肌纤维 ,临床应用DIEP皮瓣再造乳房 4例 ,修复胸壁缺损 2例 ,皮瓣面积 (10cm× 12cm )～ (12cm× 35cm) ,全部成活 ,效果满意。　结论　DIEP皮瓣是对传统的TRAM皮瓣的一种技术改良 ,既保留了TRAM皮瓣血运丰富、组织量大、易于塑形的优点 ,尚可保持腹直肌的完整性 ,同期进行腹壁整形     

Dual perforator propeller internal mammary artery perforator (IMAP) flap for soft-tissue defect of the contralateral clavicular area

The internal mammary artery perforator (IMAP) flap represents the evolution from axially pedicled flaps (deltopectoral flap) to perforator flaps. Both flaps are typically used for neck and tracheostoma reconstruction in male patients. We present the case of a 68-year-old obese female patient with a right upper thoracic radionecrosis secondary to breast irradiation. Soft-tissue defect measured 12×18cm. She also complained of left breast hypertrophy. Following radical debridement, a left IMAP flap extending from midline to the anterior axillary fold was raised, based on the second and fourth IMAP vessels. The flap was rotated 180° on its second and fourth perforators to cover the defect and the left breast was reshaped. The flap survived entirely and wound healing was uneventful. Ptosis and breast hypertrophy were corrected at the same time. The IMAP flap can be harvested all the way to the anterior axillary fold and used as a large propeller flap, which makes this flap suitable for contralateral thoracic reconstructions, even in female patients.     

Free transverse rectus abdominis myocutaneous flap for breast reconstruction in patients with prior abdominal contouring procedures

With an increasing number of women undergoing abdominal liposuction and abdominoplasties, patients who have a history of an abdominal-contouring procedure are now presenting to plastic surgeons with breast cancer and are interested in autologous breast reconstruction. Based on the principle of vascular ingrowth and experience of seeing intact perforators arise from the rectus abdominis muscle in repeat abdominoplasty patients, it was hypothesized that these new perforators could adequately and safely supply the abdominal skin island as a flap in this patient population. A retrospective chart review was performed searching for cases of free transverse rectus abdominis myocutaneous (TRAM) or deep inferior epigastric perforator (DIEP) flap breast reconstruction in patients with a prior history of either abdominal liposuction, abdominoplasty, or both. Three successful cases of free TRAM flap breast reconstruction were performed in patients who had undergone previous full abdominoplasties. Additionally, three successful cases of free TRAM or DIEP flaps were performed in patients after abdominal liposuction. Major complications included one anterial thrombosis in which the flap was salvaged. This study demonstrates the feasibility and viability of free TRAM flaps after previous abdominoplasty and DIEP flaps following prior abdominal liposuction. This is an important advance in the potential uses of the free TRAM flap.     

Thoracodorsal artery perforator (TDAP) flap in immediate breast reconstruction and the role of preoperative mapping: a clinical experience

Background

Oncoplastic approach to reconstruct partial breast resection is always challenging. Nowadays, pedicle perforator flaps have been described for partial breast mastectomy reconstruction

Methods

The study comprised all patients who received partial breast resection due to external quadrant breast cancers and who were reconstructed with thoracodorsal perforator flap between August 2010 and August 2011. Twenty-two patients received the thoracodorsal artery perforator (TDAP) for breast reconstruction. The mean surgical time (including oncology resection and reconstruction) was 160 min. Eleven patients (50 %) underwent Doppler and Computed tomographic angiography (AngioCT) presurgical planning, the rest Doppler alone.

Results

The mean stay was 3.27 days. Seroma formation in the donor site was found in five cases. No flap failures were detected. No breast size changes were observed after surgical and radiotherapy treatment.

Conclusions

We conclude that TDAP flap is suitable for partial breast reconstruction (quadrantectomy) in moderate breast cancer. Level of Evidence: Level IV, therapeutic study.     

Free DIEAP and SGAP flap breast reconstruction after abdominal/gluteal liposuction.

Perforator flaps are widely used in our unit for breast reconstruction. They provide ample tissue with minimal donor site morbidity together with long lasting aesthetic results. Increasing number of patients may have liposuction procedure which may jeopardise areas such as the abdomen and the buttock which are the donor sites for perforator-free flaps in breast reconstruction. Therefore, liposuction has been considered as a relative contraindication of raising perforator flaps. Six patients who had previous liposuction of the donor sites underwent autologous breast reconstruction with perforator-free flaps. Colour Duplex imaging was obtained in all cases preoperatively in order to evaluate the blood supply to the flap and to map the perforators. There were five deep inferior epigastric artery flaps (DIEP) and one superior gluteal artery perforator (SGAP) flap used. Total flap survival was obtained in all cases. Postoperative course was uneventful. Our results showed that raising perforator flaps after liposuction of the donor sites is possible. Preoperative radiological evaluation of the perforators is mandatory for such difficult cases.     

穿支皮瓣修复四肢创面临床应用56例

目的 探讨应用穿支皮瓣修复四肢创面的临床效果。方法 自2016年11月至2018年10月,采用股前外侧穿支皮瓣(ALTP)、腹壁下动脉穿支皮瓣(DIEP)、骨间后动脉穿支皮瓣(PIAP)、胸背动脉穿支皮瓣(TDAP)、腓肠内侧动脉穿支皮瓣(MSAP)、桡侧副动脉穿支皮瓣(RCAP)游离移植修复四肢创面56例,软组织缺损面积1.5 cm×1.5 cm~ 10.0 cm×24.0 cm,皮瓣切取面积2.0 cm×2.0 cm~ 11.0 cm×25.0 cm。供区均直接缝合关闭。术后观察皮瓣成活与创面愈合情况,定期随访皮瓣外观、质地、肢体功能恢复及皮瓣供区外形及功能。结果 1例DIEP移植术后第3天发生静脉危象,经手术探查重新吻合静脉后成活,皮瓣远端部分表皮坏死,经换药治疗后愈合;其余55例皮瓣均顺利成活,皮瓣受区与供区创口均一期愈合。术后6~ 18个月随访,皮瓣颜色正常,质地柔软,肢体功能恢复良好,皮瓣供区仅残留线形瘢痕,功能无影响。结论 穿支皮瓣修复四肢创面疗效可靠,可以推广应用。