岛状皮瓣和肌皮瓣在慢性难愈性创面修复中的应用

Application of island skin and musculocutaneous flaps in repairation of chronic unhealing wounds

目的探讨利用岛状皮瓣和肌皮瓣治疗慢性难愈性创面的临床效果。方法 2008年10月至2011年5月,对15例慢性难愈性创伤性溃疡、8例静脉性溃疡、5例压力性溃疡、3例糖尿病性溃疡采用桡动脉逆行岛状皮瓣、小腿外侧逆行岛状皮瓣、胫后动脉逆行岛状皮瓣、足背动脉岛状皮瓣、足底内侧动脉岛状皮瓣、腓肠神经营养血管蒂逆行岛状皮瓣、臀大肌岛状肌皮瓣进行修复,对修复情况进行分析和总结。结果 1例皮瓣远端坏死约2.5 cm×2.0 cm,经植皮治愈;1例皮瓣发生血管危象,经及时正确处理皮瓣血运恢复正常;其余皮瓣全部成活,创面均一次性修复。随访其中23例患者4个月至3年,皮瓣外观好,溃疡无复发。结论岛状皮瓣和肌皮瓣是修复慢性难愈性创面的理想方法,它可以有效提高慢性难愈性创面的治愈率和治疗效果。应根据创面的部位、大小、深度、创面处组织特点以及血管条件等综合因素,选择相应的岛状皮瓣和肌皮瓣。

Objective To investigate the clinical effects of island skin and musculocutaneous flaps in the treatment of chronic unhealing wounds.Methods From December 2008 to May 2011,15 patients with chronic unhealing traumatic ulcer,8 cases of venous ulcer,5 cases of pressure ulcer and 3 cases of diabetic ulcer were treated with various transfered island skin and musculocutaneous flaps,such as radial artery retrograde island flap,lateral crural reversed island flap,retrograde island flap of posterior tibial artery,dorsalis artery island flap,medial plantar island flap,reversed sural neurovascular island flap,gluteus maximus island myocutaneous flap.To analyze and summarize the measures and results of the repairation of these nonhealing wounds.Results All the wounds were healed completely.In 1 case,the distal end of the flap necrosed for 2.5 cm×2.0 cm and secondary free-skin grafting was conducted.In another case,the flap appeared vascular crisis at early postoperative period,the revascularization returned to normal by timely and correct treatments.Among the other cases,the flaps all survived and the wound surfaces were repaired by once procedure.23 cases were followed up for 4 months to 3 years,the appearance of the transfered island skin and musculocutaneous flaps was good,no ulcer recurrence happened.Conclusion It is an ideal method to repair chronic nonhealing wounds with the above-mentioned island skin and musculocutaneous flaps,which can increase the cure rate and curative effects of chronic nonhealing wounds.The island skin and musculocutaneous flaps should be chosen according to the position,size,depth of the wounds and the condition of adjacent skin and soft tissues.