手术切除+局部推进皮瓣修复术后慢性难愈性切口的临床观察

目的评价手术切除+局部推进皮瓣修复术后难愈性切口的临床效果及病理学分析。 方法选择2016年2月至2021年1月就诊于首都医科大学附属北京世纪坛医院整形美容外科的42例术后难愈性切口患者，完善术前检查后，择期行手术修复，在难愈性切口外围0.5~1.0 cm处设计切口线，在局部麻醉或全身麻醉下彻底切除切口与基底病变组织，深至深筋膜或肌膜，应用局部推进皮瓣修复缺损。观察术后皮瓣血运、切口愈合时间与愈合情况。切口与切口外围组织行病理检查，观察组织炎症反应及炎症细胞浸润情况。 结果术后局部皮瓣血运正常，切口未出现红肿、疼痛等感染迹象，所有患者均Ⅰ期愈合，愈合时间为(12.0±3.0) d。病理检查显示难愈性切口中心组织炎症反应重，可见淋巴细胞[(140±21)个/HPF]浸润，切缘组织结构接近正常。术后随访2~6个月，切口无复发。 结论手术彻底切除慢性难愈性切口及外围0.5~1.0 cm处炎症病变组织，应用局部推进皮瓣可Ⅰ期修复创面，术后随访无复发，手术效果满意，值得临床应用推广。

Clinical observation of surgical resection and local advancement flap repair of the postoperative chronic refractory incision

ObjectiveTo evaluate the clinical effect of surgical resection and local advancement flap repair of the postoperative chronic refractory incision. MethodsFrom February 2016 to January 2021, 42 patients with postoperative chronic refractory incision were selected from the Department of Plastic and Aesthetic Surgery, Beijing Shijitan Hospital, Capital Medical University. After improved the preoperative examination, the patients were scheduled to undergo surgical repair. The incision line was designed at 0.5 to 1.0 cm around the refractory incision. The incision and the lesion of the base were completely removed, down to the deep fascia or sarcolemma under local or general anesthesia, and the defect was repaired by local advancement flap. The blood supply of the flap and the incision healing time and condition of wound healing were observed. Pathological examination was performed to observe the inflammatory reaction and inflammatory cell infiltration of the incision and peripheral tissue of the incision. ResultsThe blood supply of the local flap was normal after operation, and there were no signs of infection such as redness, swelling and pain. All patients healed in Ⅰ stage. The incision healing time was (12.0±3.0) days. Pathological examination showed that the inflammation in the center of the incision was serious, lymphocyte infiltration (140 ± 21) cells /HPF, and the structure of the cutting edge was normal. Following up for 2- 6 months, there was no recurrence of the wound. ConclusionsThe refractory incision and the inflammatory lesion at 0.5-1.0 cm around the incision are completely removed, and the wound surface can be repaired in Ⅰ stage with local advancement flap. There is no recurrence after follow-up, and the operation effect is satisfactory. It is worthy of clinical application and promotion.