皮瓣分次去脂整形与一次修薄植皮的临床对比研究

CLINICAL COMPARATIVE STUDIES ON MULTIPHASE LIPECTOMY AND ONE-PHASE LIPECTOMY WITH SKIN GRAFT TRANSPLANTATION IN SKIN FLAP CONTOURING

目的探讨针对皮瓣术后臃肿两种整形术的优缺点,为皮瓣的整形提供最佳的术式选择。方法2002年3月～2006年3月,收治59例皮瓣术后臃肿患者。40例采用分次去脂整形术。男32例,女8例;年龄4～63岁,平均34岁。皮瓣类型:腹部皮瓣19例,髂腹股沟皮瓣10例,胸部皮瓣4例,游离股前外侧皮瓣6例,交腿皮瓣1例。皮瓣范围6cm×4cm～32cm×17cm。19例采用一次修薄植皮术。男16例,女3例;年龄7～42岁,平均28岁。皮瓣类型:腹部皮瓣4例,髂腹股沟皮瓣6例,胸部皮瓣3例,游离股前外侧皮瓣6例。皮瓣范围4cm×3cm～17cm×8cm。结果分次去脂整形术后4例出现皮瓣边缘部分坏死,余皮瓣均成活。27例患者获随访3个月～2年。皮瓣外观、质地及色泽良好,与深层组织无粘连;22例随体重增加出现皮瓣臃肿;皮瓣范围>5cm×5cm者术后感觉恢复差,仅有部分痛温觉恢复,两点辨别觉均无恢复。一次修薄植皮术后1例植皮完全坏死,经再次植皮愈合;2例部分坏死,经换药后创面愈合,余植皮均成活。16例获随访3个月～3年。植皮皮肤色素沉着较重,皮肤与基底无滑动,皮肤感觉恢复良好,12例恢复两点辨别觉(<15mm),皮瓣无臃肿复发。结论分次去脂整形和一次修薄植皮各有其优缺点,应根据皮瓣修复部位及状况决定术式的选择。

Objective To discuss the advantages of two flap contouring methods and to explore the best choice for the flap contouring. Methods From March 2002 to March 2006, 59 patients were admitted for a flap-contouring operation. Of the 59 patients, 40 （32 males, 8 females; average age, 34 years） underwent the multiphase lipectomy （the muhiphase lipectomy group）. The original flaps included the abdominal flap in 19 patients, the groin flap in 10, the thoracic flap in 4, the free anteriolateral thigh flap in 6, and the cross leg flap in 1. The flaps ranged in size from 6 cm × 4 cm to 32 crux 17 cm. However, the remaining 19 patients （16 males, 3 females; average age, 28 years） underwent the one phase lipectomy with skin graft transplantation（the one-phase lipectomy group）. The original flaps included the abdominal flap in 4 patients, the groin flap in 6, the thoracic flap in 3, and the free anteriolateral thigh flap in 6. The flaps ranged in size from 4 cm ×3 cm to 17 cm × 8 cm. The results were analyzed and compared. Results In the multiphase lipectomy group, partial flap necrosis developed in 4 patients but the other flaps survived. The followed-up of 27 patients for 3 months to 2 years revealed that the flaps had a good appearance and texture, having no adhesion with the deep tissues. However, the flaps became fattened in 22 patients with their body weight gaining. The patietns who had a flap 〉 5 crux 5 cm in area had their sensation functions recovering more slowly; only part of the sensations to pain and heat recovered. The two point discrimination did not recover. In the one-phase lipectomy group, total graft necrosis developed in 1 patient but the healing was achieved with additional skin graft transplantation; partial graft necrosis developed in 2 patients but the wounds were healed after the dressing changes; the remaining flaps survived completely. The follow-up of the 16 patients for 3 months to 3 years revealed that all the 16 patients had a good sensation recovery, 12 patients had the two point discrimination 〈15 mm, with no recurrence of the fattening of the flaps; however, the grafted skin had a more severe pigmentation, and no sliding movement developed between the skin and the tissue basement. Conclusion The multiphase lipectomy and the one-phase lipectomy with skin graft transplantation are two skin flap contouring methods, which have their own advantages and disadvantages. Which method is taken should be based on the repair location of the skin flap and the condition of the skin flap.