游离旋髂浅动脉皮瓣修复足部皮肤缺损的临床应用

Clinical application of free superficial iliac circumflex artery skin flapin repairing skin defect of foot

目的探讨游离旋髂浅动脉皮瓣修复足部皮肤缺损的临床效果。方法 2015年5月—2017年4月周口淮海医院采用游离旋髂浅动脉皮瓣修复足部皮肤缺损13例,其中男性10例,女性3例;年龄13～65岁,平均37. 5岁。致伤原因:道路交通伤4例,机械绞伤3例,压砸伤6例。皮肤软组织缺损范围4. 0cm×6. 5cm～9. 0cm×12. 5 cm,创面均不同程度存在泥沙、碎屑等异物残留,并伴有足部的肌腱、骨骼等深部组织损伤外露。皮瓣切取范围为5. 0cm×7. 0cm～10. 0cm×14cm,其中急诊修复4例,经清创术后应用VSD技术处理7～10d,择期修复创面9例。结果 11例皮瓣完全成活,2例皮瓣边缘局部皮肤坏死,经拆线、换药等对症治疗后创缘愈合。供区切口均Ⅰ期愈合。13例经术后6个月～2年随访,皮瓣外形满意及足部功能恢复满意,无皮肤破溃及磨损现象,患足负重、行走功能恢复良好。结论应用游离旋髂浅动脉皮瓣修复足部皮肤缺损,临床效果良好。

Objective To explore the clinical effect of free superficial iliac circumflex artery skin flaps in repairing skin defect of foot.Methods Thirteen patients with foot skin defect repaired by free superficial iliac circumflex artery skin flap in Huaihai Hospital of Zhoukou from May 2015 to Apr.2017 were studied.Of the 13 patients,there were 10 males and 3 females,with the average age of 37.5 years ranging from 13 to 65 years old.The causes of injury included traffic accident injuries in 4 cases,wringer injuries in 3 cases,and crush injuries in 6 cases.The scope of skin and soft tissue defects ranged from 4.0cm×6.5cm to 9.0cm×12.5cm.Besides,there were foreign body residues such as sediment and debris in the wound surface to varying degrees,accompanied by deep tissue defects and exposure such as tendons and bones in the feet.The selected size of the flap was 5.0cm×7.0cm to 10.0cm×14cm.Furthermore,there were 4 patients with emergency repair.After debridement,VSD was used for 7 to 10 days of treatment,among which 9 cases received selective repair.Results Complete survival was achieved in 11 flaps,2 flaps had local skin necrosis on the edge of flap,with wound healed after suture removal,dressing change and other symptomatic treatment.All incisions at donor sites exhibited phase I healing.All the 13 cases were followed up for 6 months to 2 years after operation.The shape of the flap was satisfactory and the function of the foot recovered satisfactorily.There was no skin ulceration or abrasion,and the bearing and walking function recovered well in the injured foot.Conclusion The free superficial iliac circumflex artery skin flaps can achieve good clinical effect in repairing skin defect of foot.