猪脱细胞真皮基质暂时闭合联合皮瓣蒂部回植修复腹部供瓣区的效果观察

Effect of porcine acellular dermal matrix temporarily cover combined with flap pedicle replantation for repairing the donor site of abdominal flap

目的观察猪脱细胞真皮基质暂时闭合联合皮瓣蒂部回植对腹部供瓣区的影响。方法选取2010年1月至2016年12月北京积水潭医院收治的肘、前臂、手深度电烧伤、热压伤、外伤后软组织缺损伴内固定外露患者21例。清创后软组织缺损范围为7 cm×6 cm^11 cm×9 cm。创面采用腹部皮瓣修复,皮瓣蒂部及供瓣区部分创面以猪脱细胞真皮基质暂时闭合,断蒂时将皮瓣蒂部修整后回植修复腹部供瓣区。术后进行门诊随访,观察皮瓣存活情况、皮瓣下组织感染、液化、坏死情况及供瓣区并发症发生情况。结果21例患者共22个创面均以皮瓣覆盖,皮瓣切取范围为10 cm×7 cm^18 cm×11 cm,20个皮瓣切取宽度为8~10 cm,其余2个皮瓣宽度分别为7、11 cm。随意腹部皮瓣4个,髂腹股沟皮瓣16个,胸脐皮瓣2个,所有皮瓣均存活良好,无皮瓣下组织感染、液化及坏死现象出现。供瓣区术后无感染、出血、血清肿、缝合口裂开并发症。随访6~24个月,腹部供瓣区仅有较轻的线状瘢痕,外观较满意。结论当采用腹部皮瓣修复肘关节至手部创面时,中小面积的供瓣区及皮瓣蒂部以猪脱细胞真皮基质暂时闭合,皮瓣断蒂时将蒂部回植至供瓣区,能预防术后供瓣区并发症,避免供瓣区植皮,改善局部外观。方法简单、易行、安全、可靠。

Objective To observe the effect of porcine acellular dermal matrix temporarily cover and flap pedicle replantation for repairing the donor site of abdominal flap.Methods From January 2010 to December 2016,21 patients suffered from deep electric burns,hot crush injuries,soft tissue defects after trauma with internal fixation exposure on elbow,forearm and hand,were treated in Beijing Jishuitan Hospital.After wound debridement,the soft-tissue defect sizes were 7 cm×6 cm-11 cm×9 cm.Abdominal flaps were cut to repair above wounds respectively.The pedicle and part of donor site of the abdominal flap were temporarily covered with porcine acellular xenogeneic dermis matrix.Flap pedicle was modified and replanted to the donor site of the abdomen flap when pedicle was separated.Flap survival,tissue under the flap infection,liquefaction,necrosis,the complications of the donor site were observed after outpatient follow-up.Results Flap survival was complete in all 22 wounds of 21 patients,the flaps created were 10 cm×7 cm-18 cm×11 cm,the width of flap pedicle were 8-10 cm in 20 flaps,and the remaining 2 flaps had a pedicle width of 7 cm and 11 cm,respectively.A total of 4 random flaps,16 iliovaginal flaps and 2 thoracic-umbilicus flaps were used.No tissue infection,liquefaction,necrosis occurred under the flaps.No infection,hematoma,seroma and wound dehiscence happened on the donor site.During a fellow-up of 6-24 months,there were only light linear scars in the fiap of donor site,and the appearance was satisfactory.Conclusions When abdominal flap is used to repair elbow joint to hand wound,the small and medium area of the flap donor site and skin flap pedicle are temporarily closed with porcine acellular dermal matrix.When the flap pedicle is separated,the pedicle is transplanted back to the flap donor site to prevent postoperative complications in the flap donor site,and can avoid skin graft in the flap donor site and improve local appearance.The method is simple,easy,safe and reliable.