带蒂髂腹股沟皮瓣在儿童手爆炸伤中的临床应用

Clinical application of pedicled iliac inguinal flap in children explosive hand blast injury

目的探讨在儿童手爆炸伤治疗中应用带蒂髂腹股沟皮瓣修复创面的临床效果。方法 2014年1月-2017年4月,对手爆炸伤的患儿急诊行伤口清创,固定骨与关节,修复肌腱、血管及神经,视组织损伤及创面情况,Ⅰ期行带蒂髂腹股沟皮瓣修复创面或行VSD治疗3~6 d后Ⅱ期行带蒂髂腹股沟皮瓣修复创面;皮瓣切取面积为6 cm×11 cm^10 cm×18 cm。3周后行皮瓣断蒂修整术。结果临床应用21例,2例分叶皮瓣部分远端坏死,经局部换药后创面逐渐愈合,其余19例皮瓣成活良好;3例皮瓣稍臃肿,其余18例皮瓣外观及质地满意;患肢活动功能恢复基本满意。结论应用带蒂髂腹股沟皮瓣修复儿童手爆炸伤创面具有操作简单、成活率高、供区隐蔽等优点,是理想的治疗方法。

Objective To investigate the clinical effect of pedicled iliac inguinal flap on the treatment of hand explosive injury in children. Methods Emergency debridement, fixation of bones and joints, repair of tendons, blood vessels and nerves were performed in children with explosive injuries, according to the damage of the tissue and wound condition, one stage pedicled iliac inguinal flap was used to repair the wound or VSD negative pressure drainage 3~6 days later two pedicle iliac inguinal flap was used to repair the wound. The area of the skin flap was 6 cm×11 cm^10 cm×18 cm. Skin flap pedicle was divided after3 weeks. Results There were 21 cases of clinical application, 2 cases of partial distal necrosis of lobulated flap, and wound healied gradually after local dressing change, and the remaining 19 cases survived well;Skin flap was slightly bloated in 3 cases, and the appearance and texture of the flap were satisfactory in 18 cases. The recovery of the active function of the affected limbs was basically satisfactory. Conclusion The application of pedicled iliac inguinal flap in the repair of children’s hand explosive wound has the advantages of simple operation, high survival rate and concealed donor area, it is an ideal treatment.