以腹壁下血管为蒂的脐旁皮瓣修复骨盆区域软组织缺损八例

Paraumbilical flap pedicled with deep inferior epigastric vessel for the repiration of soft tissue defects in pelvic area:8 cases report

目的探讨采用以腹壁下血管为蒂的脐旁皮瓣修复骨盆区域软组织缺损的手术方法和临床疗效。方法自2006年8月至2018年8月,应用腹壁下血管为蒂脐旁皮瓣修复8例骨盆区域的软组织缺损创面,男6例,女2例,年龄12~47岁,平均35.3岁。其中交通事故伤5例,高处坠落伤1例,恶性神经鞘瘤切除术后创面1例,骨盆骨折切开复位内固定术后软组织坏死1例。所有创面均伴有骨外露,软组织缺损位于髂嵴5例,坐骨结节2例,臀部及会阴部1例。创面大小为11.0 cm×6.0 cm^22.0 cm×8.0 cm,皮瓣面积13.0 cm×7.0 cm^29.0 cm×12.0 cm。术后通过门诊、电话、微信随访。结果术后8例脐旁皮瓣全部成活,创面感染均得到控制。所有患者术后随访12~46个月,平均26个月,皮瓣成活良好,皮瓣弹性、质地均较好;随访期内感染无复发,供区均未见腹壁疝形成。结论腹壁下血管为蒂的脐旁皮瓣转位是修复髂嵴、会阴部、臀部及坐骨结节处大面积软组织缺损的一种可靠的手术方法。

Objective To explore surgical techniques and summarize surgical experience of the paraumbilical flap pedicled with deep inferior epigastric vessels for the repiration of soft tissue defects in pelvic area.Methods Between August,2006 and August,2018,8 patients with soft tissue defects and bone exposure were treated with paraumbilical flap pedicled with deep inferior epigastric vessels.There were 6 males and 2 females with the average age of 35.3(range,12-47)years.The defects were caused by car accident in 5 cases,by high falling injury in 1 case,by soft tissue necrosis after malignant schwannoma resection in 1 case,and by soft tissue necrosis after pelvic operation of open reduction internal fixation in 1 case.The defects located at iliac spine in 5 cases,at tuber ischii in 1 case,and at buttock and perineal region in 1 case.The size of the wounds ranged from 11.0 cm×6.0 cm to 22.0 cm×8.0 cm.The size of the flaps ranged from 13.0 cm×7.0 cm to 29.0 cm×12.0 cm.The followed-up was made by outpatinet service,telephone or WeChat.Results All flaps survived,and the wound infection was controlled.The followed-up time ranged from 12 to 46(mean 26)months.All flaps survived uneventfully,and the texture and elasticity of the flaps were good.There were no recurrence of infection,and no ventral hernias occurred in donor sites.Conclusion The transfer of paraumbilical flap pedicled with deep inferior epigastric vessels is a reliable method to repair large soft tissue defects in iliac spine,perineal region,buttock and tuber ischii.