应用彩色多普勒超声设计轴型皮瓣修复乳腺癌术后放射性溃疡的临床疗效

Clinical efficacy of color Doppler ultrasound-designed axial skin flap in the repair of radiation ulcer after breast cancer surgery

目的观察应用彩色多普勒超声设计轴型皮瓣修复乳腺癌根治术后胸壁放射性溃疡的临床疗效。方法回顾性分析应用彩色多普勒超声设计轴型皮瓣修复乳腺癌根治术后胸壁放射性溃疡16例患者的临床资料。术前均采用彩色多普勒超声血管探查仪在皮瓣设计区探查并体表标记轴心血管及其主要穿支的走向,并对血管管径及血流参数进行评估,再结合创面大小及部位设计背阔肌皮瓣或腹直肌皮瓣以覆盖创面。皮瓣转移后术中再次应用彩色多普勒超声探查皮瓣血运情况,评估手术效果。结果所有患者轴心血管术前与皮瓣转移后术中彩色多普勒超声血管探查定位吻合率为100%。其中1例腹直肌皮瓣转移患者术后10 d出现远端局部坏死,经再次清创、局部皮瓣转移后创面愈合;其余15例患者均一期愈合。术后住院时间为(14.8±3.2)d。术后随访6个月至4年,其间所有患者皮瓣均完全存活,血运良好,外观、质地柔软,存活率为100%,且均无溃疡复发。结论应用彩色多普勒超声设计轴型皮瓣修复乳腺癌术后胸部放射性溃疡疗效良好,皮瓣存活率高,溃疡复发率低。

Objective To observe the clinical efficacy of axial skin flaps designed by color Doppler ultrasound in the repair of chest wall radiation ulcer after radical mastectomy.Methods Clinical data of 16 patients who received the repair for chest wall radiation ulcer after radical mastectomy with axial skin flaps designed by color Doppler ultrasound were analyzed retrospectively.Before operation,color Doppler ultrasonic vascular detector was employed to detect the direction of axial vessels and their main perforating branches in the design area of skin flaps,and a mark on the body surface was conducted;in addition the diameter of blood vessels and blood flow parameters were evaluated.Latissimus dorsi flaps or rectus abdominis flaps were designed to cover the wound according to the size and location of the wound.The blood supply of flaps was reassessed intraoperatively by color Doppler ultrasound after flap transfer,and the effect of operation was evaluated.Results The coincidence rate between preoperative axial vessels localization and intraoperative axial vessels localization after flap transfer by color Doppler ultrasound exploration was 100% in all of the patients.Of which one patient with rectus abdominis flap transfer had local necrosis at the distal end 10 days after operation,the wound healed after another second debridement and local skin flap transfer;the other 15 patients all healed at the first stage.The hospital stay after operation was(14.8+3.2) days.All patients were followed up for 6 months to 4 years,all the flaps survived completely with good blood supply,soft appearance and texture,a survival rate of 100%,and without ulcer recurrence.Conclusion Color Doppler ultrasound-designed axial skin flaps in the repair of chest wall radiation ulcer after radical mastectomy has a good curative effect,a high survival rate of skin flaps and a low recurrence rate of ulcer.