个性化设计腹壁下动脉穿支皮瓣在修复四肢皮肤软组织缺损中的临床应用

The clinical application of individual design deep inferior epigastric perforator flap for resurfacing the various types of soft tissue defects in extremities

目的 探讨个性化设计腹壁下动脉穿支皮瓣（DIEP）修复四肢不同类型皮肤软组织缺损的可行性及其临床效果.方法 2007年9月至2017年10月收治各种病因导致的四肢皮肤软组织缺损病例93例,均伴有不同程度的深部组织外露或死腔形成.根据创面的不同特性,采用个性化设计DIEP修复.根据患者满意度评价供区瘢痕优良率.结果 本组病例采用带血管蒂DIEP移位修复8例,传统DIEP游离移植47例,嵌合DIEP 8例,分叶DIEP 13例,显微削薄DIEP 12例,联体DIEP 1例,flow-through DIEP 2例,分叶-嵌合DIEP 1例,显微削薄-分叶DIEP 1例.皮瓣切取面积7 cm×4 cm- 36 cm×11 cm.供区均直接缝合.术后除2例因血管危象坏死外（再次行皮瓣移植修复）,其余皮瓣均顺利存活.术后随访5 - 24个月,平均12.4个月,所有皮瓣颜色正常、质地柔软,15例（16.1％）患者经历二期修薄整形.术后皮瓣供区腹壁功能无影响.横行设计皮瓣32例,斜行设计46例,不规则设计13例,纵行设计2例.采用横行设计、斜行设计、不规则设计皮瓣供区瘢痕优良率分别为86.9％、70.0％、37.5％.结论 根据四肢创面的不同特性设计合适术式的DIEP修复,可以获得满意的临床效果.

Objective To explore the feasibility and efficiency of deep inferior epigastric perforator flap （DIEP） based on individual design which was used for reconstructing the various types of soft tissue defects in extremities.Methods From September 2009 to October 2017,ninety three patients were included for respective analysis who presented with bone and tendon exposure or dead space,and reconstructed through individualized DIEP flaps in our department.We evaluated the appearance of donor site according to patients＇satisfaction.Results Eight patients had pedicle DIEP flaps,47 patients were treated with free traditional DIEP flaps,and 38 cases underwent with special forms of DIEP flaps.The special forms of DIEP flaps included 8 chimeric DIEP flaps,13 dual skin paddles DIEP flaps,12 microdissection DIEP flaps,1 conjoined DIEP flap,2 flow-through DIEP flaps,1 mutipaddles chimeric DIEP flap and 1 microdissection dual skin paddles DIEP.The size of flap ranged from 7 cm × 4 cm to 36 cm × 11 cm.All of the donor sites were primarily closed.Most of flaps survived,only two cases suffered with necrosis due to vascular crisis.Those patients have been followed-up from 5 to 24 months （average 12.4 months）.A good color and texture were achieved in most of recipient sites.16.1％ of patients needed the second debulking procedure.The function of abdominal wall was normal postoperatively.Transverse flap design was performed for 32 patients,oblique design for 46 patients,irregular design for 13 patients,and longitudinal design for 2 patients.The rate of excellent donor site appearance was 86.9％ in the transverse designed flaps,70.0％ for the donor site with the oblique designed flap,and 37.5％ for the donor site with the irregular designed flap.Conclusions The individualized DIEP flaps based on different wound characteristics are ideal approaches for reconstruction of various types of soft tissue defects in extremities.