带蒂旋髂浅动脉穿支皮瓣与躯干任意皮瓣修复手部电击伤致软组织缺损疗效对比

【摘要】 目的 对比分析带蒂旋髂浅动脉穿支皮瓣与躯干任意皮瓣修复手部电击伤致软组织缺损的临床疗效。方法 选取 2017 年 5 月至 2022 年 6 月河南科技大学第一附属医院收治的 82 例手部电击伤致软组织缺损患者作为研究对象, 按照不同治疗方式将其分为试验组 (40 例) 和对照组 (42 例), 试验组患者软组织缺损创面采用带蒂旋髂浅动脉穿支皮瓣进行修复, 对照组患者软组织缺损创面采用躯干任意皮瓣进行修复, 对比观察两组患者皮瓣血管蒂长度、住院时间、创面愈合时间、手指关节总主动活动度、皮瓣受区支配区域感觉功能与并发症(淋巴瘘、血管危象、瘢痕挛缩) 发生情况。 结果 试验组患者皮瓣血管蒂长度为 (7.89±1.13) cm, 明显长于对照组患者的皮瓣血管蒂长度 (6.29±1.21) cm ( t = 6.181, P<0.001); 住院时间为 (31.14±4.92) d、创面愈合时间为 (40.19±10.23) d, 明显短于对照组患者的住院时间 (33.58±5.03) d、创面愈合时间 (46.62±11.41) d(t = 2.219、2.682, P= 0.029、0.009)。 术后 4 个月, 试验组患者手指关节总主动活动度为良 20 例、中16例、差4例, 明显优于对照组患者的手指关节总主动活动度为良10例、中20例、差12例 (Z = -2.762, P = 0.006);试验组患者皮瓣受区支配区域感觉功能为 5 级8例、4级12例、3级 11 例、2 级 7 例、1 级 2 例, 明显优于对照组患者的皮瓣受区支配区域感觉功能为5级 1 例、4 级 10 例、3 级 10 例、2 级 13 例、1 级 7 例、0 级 1 例 (Z =-3.005, P= 0.002)。试验组患者术后并发症发生率为 17.50%, 明显低于对照组患者的术后并发症发生率40.48% (χ2 = 5.224, P= 0.022)。 结论 与躯干任意皮瓣相比, 带蒂旋髂浅动脉穿支皮瓣可有效修复手部电击伤所致的软组织缺损, 促进手部运动功能及感觉功能恢复, 降低淋巴瘘等并发症发生率。

Comparison of Clinical Efficacy of Pedicled Superficial Circumflex Iliac Artery Perforator Flap and Arbitrary Flap from Trunk in Repairing Hand Soft Tissue Defect Caused by Electric Shock

【Abstract】 Objective To compare the clinical efficacy of pedicled superficial circumflex iliac artery perforator flap and arbitrary flap from trunk in repairing hand soft tissue defect caused by electric shock. Methods 82 patients with hand soft tissue defect caused by electric shock, admitted to The First Affiliated Hospital of Henan University of Science andTechnology from May 2017 to June 2022, were enrolled as research subjects to be divided into the experiment group ( n =40) and the control group (n = 42) based on different treatment methods. The soft tissue defects of patients in the experiment group were repaired with pedicled superficial circumflex iliac artery perforator flap, whereas the soft tissue defects of patients in the control group were repaired with arbitrary flap from trunk. The length of flap vascular pedicle, length of stay, wound healing time, total active motion range of finger joint, sensory function of flap recipient-dominating area, and the occurrence of the complications (lymphatic fistula, vascular crisis, and scar contracture) were compared between the two groups. Results The length of flap vascular pedicle of patients in the experiment group was (7.89±1.13) cm, which was significantly longer than the (6.29±1.21) cm in the control group ( t = 6.181, P<0.001). The length of stay and wound healing time were respectively (31.14±4.92) d and (40.19±10.23) d in the experiment group, which were significantly shorter than the corresponding (33.58±5.03) d and (46.62±11.41) d in the control group ( t = 2.219 and 2.682, P =0.029 and 0.009). At four months after surgery, the total active motion range of finger joint was evaluated as good in 20 cases, fair in 16 cases and poor in 4 cases in the experiment group, which was significantly better than that in the control Group-good in 10 cases, fair in 20 cases and poor in 12 cases (Z = -2.762, P = 0.006). The sensory function of flap recipient-dominating area was grade 5 in 8 cases, grade 4 in 12 cases, grade 3 in 11 cases, grade 2 in 7 cases , and grade 1 in 2 cases in the experiment group, which was obviously superior to that in the control group - grade 5 in 1 case, grade 4 in 10 cases, grade 3 in 10 cases, grade 2 in 13 cases, grade 1 in 7 cases and grade 0 in 1 case (Z= -3.005, P= 0.002).The occurrence of complications after operation in the experiment group was 17.50%, significantly lower than 40.48% in the control group (χ2 = 5.224, P = 0.022). Conclusion Compared with arbitrary flap from trunk, pedicled superficial circumflex iliac artery perforator flap can effectively repair the hand soft tissue defect caused by electric shock, promote the recovery of motor function and sensory function of hand, and reduce the incidence of complications including lymphatic fistula.