“U”形修薄髂腹股沟皮瓣移植修复四肢皮肤软组织缺损

Repair of skin and soft tissue defects of the extremity by transplantation of a U-shaped trimmed ilioinguinal flap

目的 探讨以旋髂浅动脉为轴心动脉的髂腹股沟皮瓣“U”形修薄成真皮下血管网皮瓣进行修复四肢皮肤软组织缺损的治疗效果。方法2009年6月至2014年5月，对7例四肢皮肤软组织缺损的患者采用游离髂腹股沟皮瓣修复，其中男5例，女2例，年龄22～45岁，平均32岁。受伤原因：冲床压伤4例，热压伤1例。车祸伤2例。创面大小为14．0cm×10．0cm～6．0cm×5．0cm。均伴有不同程度的肌腱及骨质外露。皮瓣切取面积：15．0cm×11．0cm。7．0cm×5．0cm。皮瓣切取后采用轴行真皮下血管网皮瓣的“U”形超薄法进行修薄。结果术后7例皮瓣全部成活。4例获得随访，随访时间为1～6个月，平均4个月。术毕时皮瓣修薄区域色泽逐渐红润，毛细血管反应恢复良好，外观平坦。术后3个月复查，皮瓣薄而柔软，外形平坦美观，未见明显色素沉着，供区直接缝合，仅留线状瘢痕。结论采用“u”形修薄髂腹股沟皮瓣修复四肢皮肤软组织缺损，供区隐蔽、遗留瘢痕小、不影响外观；而且皮瓣色泽好、质地适中，移植后显得薄而美观，疗效满意。

Objective To explore the efficacy of transplantation of a U-shaped ilioinguinal flap in the re pair of skin and soft tissue defects of the extremity. An axial flap based on the superficial iliac circumflex artery and trimmed to a subdermal vascular network flap was used for the procedures. Methods Seven patients with skin and soft tissue defects treated between June, 2009 and May, 2014 were studied. The patients were 22-45 years of age （mean, 32 years）, and included 5 males and 2 females. Four patients had punch-press injuries, 1 patient had a hot-crush injury, and the remaining 2 patients were injured in the accidents. The wound sizes were 14.0 cm× 10.0 cm to 6.0 cm × 5.0 cm, with a varying extent of exposed tendons and bones. Repairs were performed using free ilioinguinal flaps, which were 15.0 cm × 11.0 cm to 7.0 cm × 5.0 cm in size. The axial flap was trimmed to a U-shaped subdermal vascular network flap and transplanted to the recipient site with anastomosis of blood vessels. Results All transplanted flaps survived. Four patients were followed for 1-6 months, with a mean duration of follow-up of 4 months. The trimmed flaps showed gradual reddening immediately after surgery, and the capillaries were recovered with a fiat surface. Re-examination 3 months after surgery showed that the flaps were thin and flexible and met the aesthetic demand. No obvious pigmentation occurred, and the donor site was sutured directly, leaving only linear scars. Conclusion Repair of skin and soft tissue defects of the extremity using a U-shaped trimmed ilioinguinal flap has the advantages of a hidden donor site, small scar, and conformity to aesthetic requirements. The trimmed flaps are preferred over untrimmed flaps in terms of color and texture. The former flap is thinner, meets the aesthetic demand, and achieves a better efficacy.