下腹部浅动脉游离皮瓣修复上肢皮肤软组织缺损

Repair of skin and soft tissue defects in upper limbs with low abdominal superficial artery flap

目的总结下腹部浅动脉游离皮瓣修复上肢不同部位皮肤软组织缺损的临床应用及疗效。方法对伴有深部组织外露的上肢软组织缺损42例，分别采用以旋髂浅动脉为蒂的皮瓣修复13例，以旋髂浅动脉为蒂的骨皮瓣修复5例，以腹壁浅动脉为蒂的皮瓣修复11例，皮瓣近端以旋髂浅动脉及腹壁浅动脉的外侧支为血供，皮瓣远端以第四腰动脉前支的肌皮动脉穿支为血供的多皮支供血皮瓣7例，以旋髂浅腹壁浅动脉共干、腹壁浅动脉分出的内侧支及外侧支、旋髂浅动脉发出深支和浅支三种形式设计双叶皮瓣修复6例。皮瓣面积最大为9cm×30cm，最小为5cm×6cm。结果术后皮瓣全部成活，术后随访6～24个月，外形良好，皮瓣质地柔软，皮瓣恢复保护性感觉，有排汗功能，皮瓣供区仅留线状瘢痕。结论下腹部浅动脉游离皮瓣修复上肢皮肤软组织缺损，皮瓣质地较簿，供区可直接缝合等优点，是修复上肢皮肤软组织缺损的一种较理想方法。

Objective To investigate the clinical effects of applying low abdominal superficial artery flap to repair skin and soft tissues defects in upper limbs. Methods Total 42 cases with soft tissues defects were recruited in this study. Seven cases were repaired using skin flaps with circumfiexa ilium superficial artery. Five cases were repaired using osteoeutaneous flaps based on cireumfiexa ilium superficial artery. Eleven cases were repaired using flaps with superficial epigastric artery. Seven cases were repaired using flaps with circumfiexa ilium superficial artery, lateral branches of superficial epigastric artery and musculocutaneous perforators of the fourth lumbar artery. Six cases were repaired using flaps with origin of circumfiexa ilium su- perficial artery, medial and lateral branch of superficial epigastrie artery, and the deep and cutaneous branch of circumfiexa ilium superficial artery. Results After surgery, forty-two flaps all survived. Flaps areas were between 5 cmx 6 cm-9 cmx 30 cm. Followed up 6-24 months, the appearance, texture, color and func- tion of flaps were recovered well and did not need to trim again. Conclusion Low abnominal superficial artery flap could be used to repair skin and soft tissues, also its texture is so thin and areas can be direct sutures, which, is an ideal method to forearm repairment.