游离旋髂浅动脉分叶皮瓣修复手部不规则创面的临床应用研究

Free superficial circumflex iliac artery flap for the repair of irregular wounds of hand

目的探讨以游离旋髂浅动脉为血供的分叶皮瓣修复手部多个创面缺损的临床疗效。方法回顾性分析2015年1月—2019年1月西南医科大学附属中医医院骨伤手外科应用以旋髂浅动脉为血供的分叶皮瓣修复手部多个创面缺损22例,男性15例,女性7例;年龄27~59岁,平均41.5岁。机械伤17例,压砸伤5例;手背部12例,手掌部10例。携带2个穿支,形成2个分叶皮瓣20例,携带3个穿支,形成3个分叶皮瓣2例。创面不规则,均伴有肌腱、骨骼外露,皮瓣切取面积2.0 cm×2.5 cm~3.0 cm×8.0 cm。皮瓣供区均采用美容缝合。患者均获门诊或微信定期随访,观察皮瓣的质地、颜色、外形及美观。结果皮瓣顺利成活19例,术后第1天出现动脉栓塞2例,经手术探查后血管再通畅,皮瓣完全成活,皮瓣远端少许坏死1例,经换药后愈合。随访时间3~15个月,平均10.5个月,皮瓣色泽良好,质地可,外形美观,供区美容缝合后仅留线性瘢痕。根据手外科上肢功能评定标准进行评定优16例,良6例。结论旋髂浅动脉为血供的分叶皮瓣供区隐蔽,穿支较恒定,易于解剖,可以携带多个穿支,形成分叶皮瓣,修复手部多个创面,具有良好的临床疗效。

Objective To investigate the clinical effect of free flap with superficial circumflex iliac surface as blood supply for repairing multiple wound defects of hand.Methods From Jan.2015 to Jan.2019,22 patients(15 males and 7 females,aged 27-59 years,with an average age of 41.5 years)were treated with superficial circumflex iliac flap as blood supply in the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University.There were 17 cases of mechanical injury and 5 cases of crushing injury.There were 12 cases of dorsal hand and 10 cases of palm.Two lobulated flaps were formed in 20 cases with 2 perforators and 3 perforators in 2 cases.The wounds were irregular with tendon and bone exposed.The area of flap was 2.0cm×2.5cm-3.0cm×8.0cm.The donor sites of the flaps were all sutured with cosmetic suture.All patients were followed up regularly by outpatient or wechat.The texture,color,appearance and beauty of the flap were observed.Results Among the 22 flaps,19 survived successfully.Two had arterial embolism on the first day after operation,which was eliminated after surgical exploration.One case had a little necrosis at the distal end of the flap and healed after dressing change.The average follow-up time was 10.5 months(range,3-15 months).The skin flap had good color,good texture and beautiful appearance.Only linear scar was left after cosmetic suture.According to the evaluation standard of hand surgery upper limb function,16 cases were excellent and 6 cases were good.Conclusion The flap with superficial circumflex iliac surface as blood supply has hidden donor site,stable perforator and easy dissection.It can carry multiple perforators to form a lobulated flap to repair multiple wounds of the hand.The patients are satisfied with the flap and the clinical effect is good.