腹壁下动脉及其穿支螺旋桨皮瓣手术设计与临床应用

Design and clinical applications of propeller flaps pedicled inferior epigastric artery and its perforating branches

目的 探讨应用腹壁下动脉穿支螺旋桨皮瓣修复缺损的手术设计方法和临床效果.方法 对收治的16例患者,分别采用以腹壁下动脉主干或穿支为蒂的螺旋桨皮瓣（共17个皮瓣）,修复腹部、腰部、大腿近端、胸腹部和会阴部缺损.供瓣区均直接拉拢缝合.结果 17个皮瓣中,10个皮瓣为腹壁下动脉穿支为蒂的螺旋桨皮瓣,其中9个皮瓣全部成活,1个皮瓣尖端部发生坏死;7个皮瓣为腹壁下动脉主干为蒂的螺旋桨皮瓣,其中6个皮瓣全部成活,1个皮瓣由于术后发生严重感染而出现皮瓣部分坏死,经换药处理,创面清洁后,缺损直接拉拢缝合.随访1～7年,瘢痕患者挛缩症状明显改善,肿瘤患者无复发.结论 选择恰当的病例,以腹壁下动脉主干或穿支蒂螺旋桨皮瓣修复腹部、腰部、大腿近端和会阴部缺损,是一种值得考虑的有效修复方法.

Objective To explore the design method of propeller flaps pedicled inferior epigastric artery （IEA） and its perforating branches, investigating the clinical effects. Methods Sixteen patients with the defects of the abdomen, waist, proximal portion of the thigh, anterior chest wall and perineum were treated with propeller flaps pedicled inferior cpigastric artery （IEA） or its perforating branches （including 17 flaps）. The donor area was sutured directly. Results Among the 17 flaps, 9 of 10 propeller flaps pedicled perforating branches of IEA survived and the other one was with necrosis in the apex of the flap ; 6 of 7 flaps pedicled IEA survived completely and one was with partial necrosis owning to severe postoperative infection which recovered by conservative treatment of serial dress changing and the wound was sutured directly. Follow-up was performed for 1 to 7 years, the scar contracture was greatly improved and no tumor recurrence was observed for the tumor patients. Conclusion For strictly selected patients, the propeller flap based on the main stem or its perforators of the DIEA can be a reasonable option for defective reconstruction located in the abdomen, waist, proximal portion of the thigh, and perineum：