游离穿支皮瓣对前臂和手部电击伤创面的美学修复

The clinical application of free perforator flaps in the aesthetic repair of electric burns of forearm and hand

目的探讨游离穿支皮瓣在前臂和手部电击伤创面美学修复的临床效果。方法2015年1月至2017年6月贵州省人民医院整形外科收治前臂、手部电击伤后皮肤软组织缺损患者20例,男18例,女2例,年龄20~50岁;皮肤缺损面积7 cm×5 cm^18 cm×8 cm。均采用跨区吻合血管的游离肌皮穿支单叶几何图形皮瓣移植修复。其中10例采用携带感觉神经的旋股外侧动脉穿支皮瓣,10例采用携带感觉神经的足底内侧动脉穿支皮瓣,皮瓣切取面积8 cm×6 cm^20 cm×9 cm。供区10例采用美容缝合直接关闭,10例植皮修复。结果20例移植皮瓣完全成活,其中1例术后第2天发生动脉危象,经及时手术探查,吻合血管后皮瓣成活。术后随访1~36个月,手掌、前臂外形基本满意,携带的感觉神经术后恢复大部分触觉、痛觉及温度觉,皮瓣两点辨距觉9~11 mm,术后功能恢复满意。供区愈合良好无明显瘢痕,无功能障碍。结论游离穿支皮瓣具有供区隐蔽、血供可靠、皮瓣质地近似、耐磨性好的优点,是手掌及前臂分区皮肤软组织缺损创面美学修复及功能重建的理想方法之一。

Objective The clinical application of free perforator flaps in aesthetic repairing of the wounds of electric injuries in forearms and palms.Methods 20 cases of skin tissue defects of electric injuries in forearms and palms were collected in this group,including 18 male patients and 2 female patients ranged from 20 to 50 years.The size of the skin defects are from 7 cm×5 cm to 18 cm×8 cm.20 cases of forearms and palms with electric injuries,all of which were repaired by the transplantation of free musculocutaneous perforator monoflaps with anastomosis of interregional blood vessels.10 cases of wounds in forearms were treated with lateral femoral circumflex artery perforator flaps with sensate nerves.The other 10 cases of wounds in palms were treated with medial plantar artery perforator flap with sensate nerves,with a flap area of 8 cm×6cm to 20 cm×9 cm.In the donor area,10 cases were closed with aesthetic suture and 10 cases were repaired with skin grafts.Results All flaps survived in 20 cases.Artery crisis was found in 1 case on the second day after surgery,and this flap with anastomosis of blood vessels also survived after surgical exploration without delay.The shapes and functions of palms and forearms were observed basically restored from a aesthetic point of view from a follow-up of 3 months to 36 months.Most touch,pain and warm senses were restored in cases with sensate nerves.And a two-point discrimination was 9—11 mm.A satisfactory functional recovery was achieved.The donor sites were found well-healed without any obvious scars or functional disorders.Conclusions Because of the advantages of hidden donor sites,reliable blood supply,closed texture and good abrasion-resistance,the multiple perforator sublobe flaps with sensate nerves could be adopted,and after thinning could be used as the free flaps to repair the wounds.These have predicted that this method is one of the desirable methods of aesthetic repairing and functional reconstruction of subunits skin tissue defects in palms and forearms.