软组织扩张术对穿支血管增生影响的临床研究

The clinical study of impact of skin soft tissue expansion on perforator flaps angiogenesis

目的观察软组织扩张术对穿支血管增生的影响,并探讨扩张后穿支皮瓣在面、颈、手部大面积组织缺损修复中的效果。方法 2006年2月至2012年2月我院收治20例患者,其中面颈部及上肢烧伤后瘢痕18例,手部黑毛痣2例。扩张器埋置术后1个月,通过透光试验观测扩张皮瓣穿支血管管径变化情况;分别于扩张术前及术后3个月行CT血管造影(CTA)观测组织扩张术对体表穿支血管管径影响。结果扩张1个月后行透光实验发现穿支血管开始有增粗现象,3个月后应用CTA可见扩张皮瓣穿支血管明显增粗。管径平均口径为(1.8±0.42)mm,平均增粗(35.0±8.0)%。Ⅱ期术后皮瓣血运较好全部存活,供区切口Ι期愈合,受区皮瓣血运良好。12例患者术后随访6个月至2年,皮瓣外形满意无臃肿。结论穿支皮瓣经过一段时间的扩张后,血供更加丰富,皮瓣切取面积增加,皮瓣的成活率得到提高。因此扩张术能促进穿支皮瓣血管的增生,扩张穿支皮瓣是修复面部、颈部及手部软组织缺损较理想的方法。

Objective To observe the impact of skin soft tissue expansion on perforator flap angiogenesis and to investigate the clini- cal effect of expanded perforator flap on the repair of face and upper limb defects. Methods Between February 2006 and February 2012, 18 patients with large scars on face and upper limbs, and 2 patients with melanoeytic nevus on hands were treated. Thirty days later, the diame- ter of perforator vessels from 20 patients was observed in the light after the first - stage operation. The effect of expansion on the vascular di- meter of flaps by CTA were investigated. Results Nets of vessels in the flaps after the tissue expansion were seen in the light. One month later, the diameter of perforator vessels increased. The diameter of vessels increased by 35 （ 8.0 ） %. The average diameter of vessels was （ 1.8 ：t： 0.42） mm. All flaps survived completely after the second - stage operation without vascular problems. The donor site and wound were healed by first intention. Twelve patients were followed up for 6 to 24 months. The flap appearance was satisfactory. Conclusion After the flaps have been expanded for a certain time, blood supply and the incisional area of the flap, and the survival rate of flaps are increased. Perforator flap angiogenesis could be enhanced by expansion. The expanded perforator flap is an ideal method in repairing the soft - tissue de- fects of face and hand.