浅筋膜层切取腹部穿支皮瓣修复手足背侧皮肤缺损

Repair of dorsal skin defect of hand and foot with abdominal perforator flap in subcutaneous layer

目的探讨在浅筋膜层切取以旋髂浅动脉浅支为血管蒂的腹部穿支皮瓣修复手足部背侧皮肤缺损的应用效果。方法2013年6月-2019年1月对28例手足背侧皮肤软组织缺损采用在浅筋膜层切取以旋髂浅动脉浅支为血管蒂的腹部穿支皮瓣移植修复。皮瓣切取面积3.0 cm×4.0 cm^8.0 cm×22.0 cm;厚度4.0~15.0 mm。所有皮瓣均吻合旋髂浅静脉。结果1例旋髂浅动脉浅支吻合掌背动脉的皮瓣,术后出现血管痉挛,经对症处理后成活,其余27例皮瓣全部顺利成活,无血管危象发生。术后随访6~30个月,皮瓣外观质地良,柔软,稍臃肿,腹部供区留线性瘢痕。结论在浅筋膜层切取以旋髂浅动脉浅支为血管蒂的腹部穿支皮瓣修复手足部创面缺损,较常规腹部皮瓣供区损伤更小,切取容易,手术时间短,是修复手足背侧中小面积皮肤软组织缺损较好的方法,临床效果良好。

Objective To investigate the application effect of abdominal perforator flap pedicled with superficial circumflex iliac branches in the subcutaneous layer on repairing dorsal skin defects of extremities.Methods From June 2013 to January 2019,28 cases of dorsal skin and soft tissue defects of hands and feet were repaired with abdominal perforator flap pedicled by using the superficial circumflex iliac branches.The area of the flap was 4 cm×3 cm-22 cm×8 cm,the thickness of the flap was 4-15 mm,and all the flaps were anastomosed with superficial circumflex iliac vein.Results One flap with superficial branch of circumflex iliac artery anastomosed with dorsal metacarpal artery had developed vasospasm after operation,and survived after symptomatic treatment.All the other 27 flaps survived without vascular crisis.After 6-30 months follow-up,the skin flap was good in appearance,soft and slightly bloated.There was linear scar in the abdominal donor area.Conclusion The abdominal perforator flap pedicled with circumflex iliac superficial fascia is a better method for repairing the skin and soft tissue defect of small and medium area on the dorsal side of hand and foot.Compared with the conventional abdominal flap,the skin flap with perforating branches of the superficial circumflex iliac pedicle is easier to cut,and the operation time is shorter and has better clinical effect.