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。

Application of perforator flap in repair of limb defects:56 cases report

Objective To investigate the clinical effects of perforator flaps in the repair of limb defects.Methods Anterolateral thigh perforator flap(ALTP),deep inferior epigastric perforator flap(DIEP),posterior in-terosseous artery perforator flap(PIAP),thoracodorsal artery perforator flap(TDAP),medial sural artery perforator flap(MSAP)and radial collateral artery perforator flap(RCAP)were used to repair 56 cases of limb wounds from Novem-ber,2016 to October,2018.The sizes of soft tissue defect were ranged from 1.5 cm×1.5 cm to 10.0 cm×24.0 cm,while the sizes of flap were ranged from 2.0 cm×2.0 cm to 11.0 cm×25.0 cm.The recipient sites were all sutured di-rectly.The flaps survived and wound healing were observed postoperatively.Appearance,texture,recovery of the limb function,shape and function of donor site were followed-up regularly.Results One case of venous crisis occurred on the 3rd day after inferior epigastric artery perforator flap surgery,and survived after exploratory surgery with the necrosis in the distal part of the flap,which healed after dressing.Other 55 flaps all survived.Both recipient site and donor site healed in primary union.The color of the flaps was normal.The skins were soft,and the functions of the limbs recovered well.Only a linear scar remained in the donor area without dysfunction.Conclusion The perforator flap surgery is reliable for limbs repair and can be promoted and applied.