躯干部穿支皮瓣在胸部创面修复中的应用

Clinical application of perforator flaps in chest wounds repair

目的探讨躯干部穿支皮瓣在胸部创面修复中的临床应用与选择思路。方法回顾性分析2015年5月至2019年12月,山东省立医院整形美容外科收治的14例胸部创面患者的临床资料,其中男8例,女6例,年龄17~74岁。缺损原因:瘢痕挛缩畸形切除后创面5例,良性病变6例,恶性肿瘤3例。病灶切除后缺损面积6.0 cm×8.0 cm^20.0 cm×21.0 cm,应用躯干部穿支皮瓣进行修复。术前通过多普勒超声或者CTA明确穿支血管走行,根据血管走行和穿肌点设计皮瓣范围及手术入路,于深筋膜层切取皮瓣移植到受区。术后观察皮瓣成活情况并至少随访6个月。结果本组14例患者共17块皮瓣,其中胸背动脉穿支皮瓣联合背阔肌肌皮瓣5块,胸廓内动脉穿支皮瓣8块,腹壁上动脉穿支皮瓣4块。术前所有患者均行彩色多普勒检查,对其中8例患者分别行背部胸背动脉、上胸壁胸廓内动脉穿支以及上腹壁的腹壁上动脉穿支的CTA检查,以明确标记穿支穿肌点。皮瓣面积为7.0 cm×8.0 cm^22.0 cm×22.0 cm,蒂部长度为2.0~6.0 cm。术后所有皮瓣完全成活,未发生血肿等并发症。术后随访6~26个月,患者对皮瓣外观和局部功能满意,1例胸部隆突性纤维肉瘤患者发生复发,其余患者未见肿瘤复发。结论躯干部穿支动脉血管密集,穿支皮瓣获取方便,可修复胸部面积较大皮肤软组织缺损创面,供区一期缝合,满足"受区修复重建好,供区破坏损失小"的组织移植原则。

Objective To explore the application and choice of trunk perforator flaps in chest wound repair.Methods From May 2015 to December 2019,clinical data of 14 patients using trunk perforator flap for chest soft tissue defect repair were reviewed.They were 8 males and 6 females,aged from 17 to 74 years.5 patients had wound after scar surgery.6 patients had benign lesions,and 3 patients had malignant tumors.The size of tissue defects ranged from 6.0 cm×8.0 cm-20.0 cm×21.0 cm.The perforator flaps were designed to repair different wounds.Preoperatively,the perforators are identified by ultrasound or CTA,and the flap scope and surgical approach are designed according to the perforator alignment and the perforated muscle point.Postoperatively,the survival of the flap was observed and followed up for at least 6 months.Results All 17 flaps of 14 patients survived.The flap area was 7.0 cm×8.0 cm-22.0 cm×22.0 cm,and the length of the pedicle was 2.0-6.0 cm.All patients were followed up for 6 to 26 months with satisfied result.Recurrence occurred in one of the patients with thoracic dermatofibrosarcoma protuberans.Conclusions The perforator artery of the trunk is densely and easy to obtain.The combined flaps could be used to repair large chest defects.The first-stage suture of the donor area,so it meets the organization transplantation principle of"the repair is perfect,the damage is small".