以腹壁下动脉穿支为蒂的血流桥接皮瓣修复肢体创面缺损

Flow-through deep inferior epigastric perforator flaps transplantation for reconstruction of large defects at the extremities

目的 探讨腹壁下动脉脐旁穿支血流桥接皮瓣修复四肢创面缺损的临床效果.方法 以腹壁下动脉-腹壁上动脉为轴心血管、脐旁穿支为皮瓣供血,形成血流桥接皮瓣术式移植,术后检测皮瓣感觉和神经功能,问卷调查患者对皮瓣外形满意度,对患肢功能行Enneking评分.结果 2011年12月至2012年9月,应用上述方法修复5例四肢缺损创面,创面最大面积30 cm×11 cm,最小11 cm×5 cm,皮瓣最大面积33 cm×13 cm,最小13 cm×7 cm.术后随访12 ～ 24个月,5例皮瓣均存活,桥接血管均通畅,供区切口一期愈合良好,患者对皮瓣外形满意.术后12个月感觉功能评级为S3＋级,Enneking评分达到正常侧的82％ ～95％,平均值为正常侧的87.2％.结论 腹壁下动脉脐旁穿支血流桥接皮瓣是修复肢体大面积皮肤软组织缺损的一种较好术式,修复四肢创面的同时可桥接血管缺损,并可改进为横行或斜行皮瓣术式移植.

Objective To investigate the clinical application of flow-through deep inferior epigastric perforator flaps for reconstruction of large defects at the extremities.Methoths The deep inferior and superior epigastric arteries were designed as the axial vessel and the arterial supply to the flap was the paraumbilical perforator artery.Free deep inferior epigastric perforator flaps were harvested in flow-through manners to reconstruct associated arterial defect in the wound.The sensation assessment,Enneking score,and questionnaire of the flap aesthetic were all performed during follow-up period.Results From December 2011 to September 2012,5 patients with large defects at extremities were treated.The deep inferior and superior epigastric arteries were designed as the axial vessel and the arterial supply to the flap was the paraumbilical perforator artery.The wound defects ranged form 11 cm × 5 cm to 30 cm × 11 cm.And the flap size ranged from 13 cm ×7 cm to 33 cm × 13 cm.All flaps survived completely.The recipient arteries were all bypassed well documented by color Doppler examinations.All cases had 12-24 months＇ follow-up period.The flaps had good appearance and high aesthetic satisfactory（100%）.12 months after operations,sensation assessment were all S3 ＋,and the Enneking score ratios were 82%-95%,with 87.2% in average.Conclusions Flow-through deep inferior epigastric perforator flaps are reliable and effective for reconstruction of large defects at the extremities with maintenance of the vascular status of the extremities.The flaps can also be designed in transverse or oblique mode for clinical application.