筋膜皮下组织为蒂的筋膜皮瓣在修复四肢软组织毁损性创面中的临床应用

Clinical application of fasciocutaneous flaps with adipotascial-flap pedical in repairing refractory wounds on extremities

目的探索以筋膜皮下组织为蒂的筋膜皮瓣修复四肢软组织毁损性创面的临床效果及优越性。方法四肢软组织毁损性创面共36例,其中交通事故所致外伤32例,电击伤3例,肿瘤切除后1例,患者年龄18～45岁,创面面积2cm×4cm～4cm×10cm,伤后1～18个月入院。创面周围软组织毁损严重,均为遗留的瘢痕组织。采用切取蒂部不带皮肤组织的、以深筋膜及其皮下组织为蒂的筋膜皮瓣修复此类创面。通过观察术后皮瓣存活情况及随诊皮瓣外形和功能的恢复情况,评价其疗效并总结优缺点。结果皮瓣面积2cm×4cm～4cm×10cm。36例皮瓣中29例完全存活良好;6例出现部分坏死,经换药修复;1例皮瓣皮肤层完全坏死,但皮下组织尚存活,经换药、植皮修复。术后有6例患者经济困难未能联系而失访。对其余30例进行随访半年至2年,皮瓣色泽佳,弹性好,外形满意;皮瓣较好地保护了深部组织,功能满意。结论筋膜皮下组织为蒂的筋膜皮瓣是一种新的切取方式,具有血供可靠、切取方便、供区创伤小的优点,适合修复中小面积的四肢软组织毁损性创面。

Objective To study the effects and advantages of fasciocutaneous flap with adipotascial-flap pedical in repairing refractory wounds on extremities. Methods Fasciocutaneous flaps with adipotascial-flap pedical which were used to repair the refractory wounds on extremities added up to 36 cases （truma 32 cases, burns 3 cases, tumor 1 case）. The patients’ age ranged from 18 to 45 years. Refractory wounds were characterised by severe destroy of soft tissue and scar around the wounds, which were difficult to deal with. The area of these wounds were about 2 cm×3 cm to 3 cm×9 cm. The survival rate was evaluated, and the appearance and fuctions of these flaps were observed after operation. Results The area of repairing flaps were about 2 cm×4 cm to 4 cm×10 cm. Twenty-nine cases survived, and only 7 were necrotic partly, which were cured with dressing and skin-grafting. Thirty cases were followed up. The appearance of these flaps, such as good colour, contour and ideal flexibility, and their protected fuctions were satisfied. Conclusion Using fasciocutaneous flaps with adipotascial-flap pedical to repair the refractory wounds on extremities is a new choice, because of its less injury in donor area, good blood supply and high rate of survival.