髂腹股沟穿支皮瓣移植修复四肢皮肤软组织缺损

doi:10.13418/j.issn.1001-165x.2017.02.019

摘要/Abstract

摘要：

目的　总结应用移植髂腹股沟穿支皮瓣修复四肢皮肤软组织缺损的临床疗效。方法　对29例伴有深部组织外露或骨缺损的四肢皮肤软组织缺损病例，采用髂腹股沟穿支皮瓣进行移植修复，其中采用旋髂浅动脉穿支皮瓣修复8例；采用旋髂深动脉穿支皮瓣修复4例；采用腹壁浅动脉穿支皮瓣修复8例；采用旋髂深动脉嵌合髂骨穿支皮瓣修复3例；采用髂腹股沟联体穿支皮瓣修复6例。皮瓣最小面积5.0 cm×6.0 cm，最大面积35.0 cm×15.0 cm。皮瓣供区均直接缝合。结果　术后移植皮瓣全部成活，2例发生皮瓣皮下血肿压迫出现动脉供血障碍，拆除部分缝线后血运恢复，1例发生静脉血管危象，经手术探查后恢复血运。 22例获得随访，随访时间为1~24个月，平均5个月。皮瓣质地柔软，外观较平坦,两点分辨觉10.0～20.0 mm。受区移植髂骨均生长良好，骨折完全愈合。供区见2例瘢痕稍增生，余均呈线状瘢痕愈合良好。结论　移植髂腹股沟穿支皮瓣具有供区隐蔽，可直接缝合，不损伤主干动脉等传统优点，且具有可灵活修复骨缺损，可切取大面积联体（嵌合）穿支皮瓣及可修薄等特点，是修复四肢软组织缺损较为理想的方法。

关键词: 髂腹股沟区, 腹壁浅血管, 穿支皮瓣, 移植, 皮肤软组织缺损

Abstract:

Objective　To evaluate the clinical efficacy of ilioinguinal perforator flap for repair of soft tissue defects of the extremities.　Methods　Twenty nine patients with soft tissue defects of the extremities complicated with deep tissue exposure or bone defects were recruited. All participants underwent ilioinguinal perforator flap transplantation including superficial iliac circumflex artery perforator flap repair in 8 cases, deep iliac circumflex artery perforator flap in 4, superficial epigastric artery perforator flap in 8, vascularized iliac osteocutaneous chimerical perforator flaps of deep circumflex iliac artery in 3 and ilioinguinal conjoined perforator flap in 6. The minimal flap size was 5.0 cm×6.0 cm, and the maximal flap size was 35.0 cm×15.0 cm. The flap donor site was directly sutured. Results All flaps survived after transplantation. Two patients presented with arterial blood flow disorders induced by subcutaneous hematoma of the flaps, and blood supply was restored after the stitches were partially removed. One patient experienced vascular crisis and blood supply was restored after surgical exploration. Twenty -two patients were followed up for 1 to 24 months, with 5 months on average. The flaps were characterized with soft texture and flat shape,the two-point discrimination distance ranging from 10.0 mm to 20.0 mm. The iliac bone graft in the recipient site grew well. The fracture was completely healed. Slight scar hyperplasia in the donor site was observed in 2 patients, and linear scars were observed the remaining cases.　Conclusion　Ilioinguinal perforator flap transplantation has multiple advantages, such as hidden donor site, direct suture and no major arterial injury. It can be applied for flexible reconstruction for bone defects, or harvested as a large-sized conjoined perforator flap（or chimeric perforator flap）and undergo flap thinning, making it an ideal approach for repairing soft tissue defects of the extremities.

Key words: Ilioinguinal region, Superficial inferior epigastric vessels, Perforator flap, Transplantation, Skin and soft tissue defect

顾荣,王海文,江新民,梅雄军,钟达强. 髂腹股沟穿支皮瓣移植修复四肢皮肤软组织缺损[J]. 中国临床解剖学杂志, 2017, 35(2): 211-216.

GU Rong, WANG Hai-wen, JIANG Xin-min, MEI Xiong-jun, ZHONG Da-qiang. Application of ilioinguinal perforator flap for repairing soft tissue defects of the extremities[J]. Chinese Journal Of Clinical Anatomy, 2017, 35(2): 211-216.

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