带蒂阔筋膜张肌皮瓣与髂腹股沟皮瓣联合移植修复手部及前臂复杂皮肤缺损

Double Pedicled Flap Transfer Combining Groin Flap and Tensor Fascia Lata Myocutaneous Flap to Repair Complex Skin Defects of Hand and Forearm

目的：介绍带蒂阔筋膜张肌皮瓣与髂腹股沟皮瓣联合移植治疗手部及前臂复杂创面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，4例手部洞穿伤患者，2例全手逆行撕脱伤患者，急诊一期采用带蒂阔筋膜张肌皮瓣与髂腹股沟皮瓣联合移植修复皮肤缺损。髂腹股沟部供区创面直接闭合，大腿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3周根据皮瓣夹蒂训练情况酌情断蒂，断蒂时将皮瓣内的腹壁浅神经、股前外侧皮神经分别于受区皮神经吻合。断蒂术后1~2个月分期皮瓣修整。结果：13例皮瓣全部存活，受区、供区伤口I期愈合。术后随访2~6个月，皮瓣柔软，质地良好，皮瓣温痛感觉良好，外形无臃肿，无坏死及破溃；总优良率为84.6%。结论：带蒂阔筋膜张肌皮瓣与髂腹股沟皮瓣联合移植治疗手部及前臂复杂创面，相对其他带蒂联合皮瓣移植患者手部体位较舒适，手术操作简单，安全性高，易于推广。

Objective：To introduce the surgical techniques and clinical outcomes of double pedicled flap transfer combining groin flap and tensor fascia lata myocutaneous flap to treat complex skin defects of hand and forearm. Method：Seven cases of hand or wrist and forearm were due to degloving injuries,four cases of penetrating injuries of hand,two cases of entire hand due to degloving injuries,were treated by transferring groin flap along with pedicled tensor fascia lata myocutaneous flap. All cases were treated with emergent one stage operation. The donor site of the groin flap was closed directly,while the wound at the donor site of the covered by full-tiffckness skin graft. Stitches were removed two weeks after the surgery when pedicle clamping exercise was initiated. Pedicle separation was done about after three weeks flap transfer,meanwhile sutured the nerves of flap. The groin flap and the tensor fascia lata myocutaneous flap were trimed in turn 1 month after pedicle separation.Result：Postoperatively all 13 flaps survived. Primary healing of the donor sites was fine. The patients were followed up for 2 to 6 months,the flaps were soft with good texture,bulkiness was not noted. There was no necrosis or ulceration. The total fine rate was 84.6%.Conclusion：Combined transfer of groin flap and tensor fascia lata myocutaneous flap has adequate dimension to cover the complex skin defects of hand and forearm. Surgery is simple and safe,therefore suitable for wide application. This method of combined flaps transfer is more comfortable to patient than other methods.