髂腹股沟皮瓣联合股部皮瓣带蒂瓦合移植在手部大面积套脱伤治疗中的应用

Double pedicled flap transfer combining groin flap and femoral flap to repair large size hand degloving injuries

目的介绍髂腹股沟皮瓣联合股部皮瓣带蒂移植治疗手部大面积套脱伤的手术方法和临床效果。方法对7例手、腕及前臂部广泛皮肤套脱伤的患者，采用髂腹股沟皮瓣联合股前外侧皮瓣带蒂移植修复4例，联合阔筋膜张肌皮瓣带蒂移植2例，联合股前侧皮瓣带蒂移植1例。髂腹股沟部供区创面直接闭合，股部供区创面取全厚层皮片植皮覆盖。术后半个月拆线，并进行皮瓣夹蒂训练，术后1个月根据皮瓣夹蒂训练情况酌情断蒂。急诊一期修复2例，二期修复5例。结果术后7例皮瓣全部存活，供区伤口I期愈合，随访2—6个月，皮瓣柔软，质地良好，皮瓣外形较臃肿，无坏死及破溃。结论髂腹股沟皮瓣联合股部皮瓣带蒂移植，二者瓦合可覆盖全手及前臂大面积皮肤套脱伤，手术操作简单，安全性高，易于推广；该皮瓣缺点是需二期手术断蒂，且移植皮瓣外形臃肿，需后期整形。

Objective To introduce the surgical techniques and clinical outcomes of double pedicled flap transfer combining groin flap and femoral flap to treat large size hand degloving injuries. Methods Seven cases of hand, wrist and/or forearm soft tissue defects due to degloving injuries were treated with the designed procedttre. Four cases underwent combined transfer of groin flap and pedicled anterolateral thigh flap. Two had combined transfer of groin flap and tensor fasciae latae myocutaneous flap. The other one was treated by transferring groin flap along with pedicled anterior thigh flap. The donor site of the groin flap was closed directly, while the wound at the donor site of the femoral flap was covered by htll-thickness skin graft. Stitches were removed two weeks after the surgery when pedicle clamping exercise was initiated. Pedicle separation was done about 1 month after flap transfer. Among them, 2 cases underwent emergent one stage operation, and the other 5 were treated with second stage operation. Results Postoperatively all 7 flaps survived. Primary healing of the donor sites was observed. The patients were followed up for 2 to 6 months. The flaps were soft with good texture. However flap bulkiness was noted. There was no necrosis or tdceration. Conelusion Combined transfer of groin flap and pedicled femoral flap has adequate dimension to cover the entire hand and part of the forearm when there is massive soft tissue defect due to degloving injury. The surgery is simple and safe, therefore suitable for wide application. The disadvantage of this flap transfer is that it requires a second stage pedicle separation. The flaps are bulky and require secondary debulking procedures.