阴部内动脉穿支"天使之翼"岛状皮瓣修复外阴和阴道及臀部皮肤软组织缺损六例

Repair of skin and soft tissue defects of vulva,vagina,and buttock with internal pudendal artery perforator"angel wing"island flaps in six cases

2015年11月—2017年7月,笔者单位收治外阴肿瘤切除术后外阴、阴道和臀部皮肤软组织缺损患者6例,患者均为女性,年龄45~70岁。4例患者为双侧缺损,2例患者为单侧缺损,每侧缺损面积6 cm×4 cm^12 cm×6 cm。采用阴部内动脉穿支"天使之翼"岛状皮瓣修复缺损重建外形,皮瓣面积7 cm×5 cm^14 cm×7 cm。供瓣区直接拉拢缝合。本组6例患者10个皮瓣全部成活。2例患者术后3 d切口局部感染,其中1例换药2周后愈合;另1例换药1周后清创缝合,术后1周愈合。术后随访6~12个月,肿瘤无复发,阴道无外翻,双侧重建病例外阴形态较佳,单侧重建病例对称性稍差;重建部位皮肤质地柔软,痛、温、触觉不同程度恢复,两点辨别觉距离20~30 mm,供瓣区遗留线性瘢痕、蹲跨无影响,阴道检查双侧重建病例可容纳1.5~2.0指、单侧重建病例可容纳2.0~3.0指,肛门排便正常。

From November 2015 to July 2017,six patients with skin and soft tissue defects of vulva,vagina,and buttock after resection of vulvar tumors were hospitalized in our unit.All patients were female,aged 45-70 years.Among them,four patients had bilateral defects,and two patients had unilateral defect.The defect area on each side ranged from 6 cm×4 cm to 12 cm×6 cm.Internal pudendal artery perforator"angel wing"island flaps were used to repair and reconstruct the defects.The area of flaps ranged from 7 cm×5 cm to 14 cm×7 cm.The donor sites were sutured directly.All 10 flaps of 6 patients survived.Two patients had local incision infection 3 days after operation.One of the two patients was healed 2 weeks after dressing change,and the other one underwent debridement and suture 1 week after dressing change and was healed 1 week after surgery.Follow-up for 6-12 months after surgery showed no recurrence of tumors,no eversion of vagina,better shape of vulva in bilateral reconstruction cases,and slightly worse symmetry in unilateral reconstruction cases.The skin of the reconstructed area was soft,with sensations of pain,temperature,and touch recovered in varying degrees.The distance of a two-point discrimination was 20-30 mm.Linear scars were left in the flap donor sites,with no impact on squatting or striding.In vaginal examination,1.5 to 2.0 fingers could be inserted in bilateral reconstruction cases,while 2.0 to 3.0 fingers could be inserted in unilateral reconstruction cases.The anus functioned well during defecation.