皮瓣移植修复躯干部慢性放射性溃疡疗效观察

Observation on the Curative Effect of Skin Flap Transplantation in Repairing Chronic Radiation Ulcer in the Trunk

目的总结、探讨轴型肌皮瓣及穿支皮瓣在躯干部慢性放射性溃疡中的应用体会。方法对2019年1月至2019年12月北京积水潭医院烧伤科收治的13例躯干部慢性放射性溃疡患者实施外科清创后应用腹直肌肌皮瓣、背阔肌肌皮瓣及肋间动脉穿支皮瓣进行修复,观察治疗效果。结果13例患者中行纵行腹直肌肌皮瓣修复者6例、背阔肌肌皮瓣修复者5例、肋间动脉穿支皮瓣修复者2例,除1例腹直肌肌皮瓣远端皮缘发生坏死行二次清创后愈合外,其余12例患者术后皮瓣均成活良好,创面一期愈合,愈合时间为(15.4±9.0)d,且均无明显瘢痕增生。随访3~16个月,所有患者均无溃疡复发或新溃疡形成。结论术前做好创面准备,并根据创面具体情况合理选择适宜的轴型肌皮瓣或肋间动脉穿支皮瓣治疗躯干部慢性放射性溃疡,皮瓣成活率较高,可显著提高创面修复率。

Objective To summarize and discuss the application experience of repairing chronic radiation ulcer in the trunk with axial myocutaneous flap and perforator flap.Methods Repair procedures with rectus abdominis flap,latissimus dorsi flap and intercostal artery perforator flap were performed respectively on thirteen patients with chronic radiation ulcer in the trunk,admitted to the Burns Department of Beijing Jishuitan Hospital from January 2019 to December 2019,after surgical debridement,and the curative effect was observed.Results Of 13 patients,6 patients received the vertical rectus abdominis flap transplantation for ulcer repair,5 patients received the latissimus dorsi flap transplantation,and the other 2 patients underwent the intercostal artery perforator flap transplantation.Except for one case with the vertical rectus abdominis flap transplantation realized ulcer healing after secondary debridement due to distal flap edge necrosis,the other12 patients showed well growth of transplanted skin flaps,and achieved first-intention wound healing.The healing time of the 12 patients was(15.4±9.0)days,and no obvious hyperplastic scar was observable.During the follow-up of 3-16 months,no ulcer relapse or new ulcer was observed in all the patients.Conclusion Doing good preoperative preparation and choosing the proper axial myocutaneous flap or intercostal artery perforator flap based on the concrete wound condition to treat the chronic radiation ulcer in the trunk can improve the survival rate of skin flaps and the recovery rate of wounds.