携带双侧腹壁浅动脉的下腹壁联体皮瓣修复足踝大面积软组织缺损

The lower abdominal conjoined flap with bilateral superficial inferior epigastric arteries for repairing the large soft tissue defects on the foot and ankle

目的探讨携带双侧腹壁浅动脉(superficial inferior epigastric arteries,SIEA)的下腹壁联体皮瓣修复足踝大面积软组织缺损的临床疗效。方法回顾分析2017年10月—2020年1月收治的18例足踝部大面积软组织缺损患者临床资料。男12例,女6例;年龄25~62岁,中位年龄35岁。致伤原因:机器绞伤9例,交通事故伤5例,切割伤2例,电击伤2例。所有创面均伴有血管、肌腱及骨、关节外露。创面部位:踝部8例,足背6例,足底4例。入院后急诊彻底清创(清创后缺损范围为15 cm×10 cm~25 cm×16 cm)及创面封闭负压引流,清创至皮瓣修复时间为3~10 d,平均5 d。根据缺损部位及范围,制备携带双侧SIEA的下腹壁联体皮瓣,皮瓣切取范围为15 cm×10 cm~25 cm×16 cm;血管蒂长度为4.5~7.5 cm,平均6.0 cm;皮瓣厚度为0.5~1.2 cm,平均0.8 cm。腹部供区均一期闭合。结果术中1例因一侧SIEA缺如,改为携带双侧旋髂浅动脉的髂腹股沟联体皮瓣修复缺损。除1例皮瓣出现远端坏死,经二期植皮修复后愈合;其余皮瓣全部成活,供受区创面均Ⅰ期愈合。患者均获随访,随访时间12~28个月,平均16个月。皮瓣外形满意,质地柔软,未出现异常毛发生长及明显色素沉着。供区仅遗留线性瘢痕,未出现腹疝等并发症。足踝功能满意,末次随访时美国矫形足踝协会(AOFAS)评分达优16例、良2例。结论携带双侧SIEA的下腹壁联体皮瓣供区隐蔽,穿支搭配灵活,皮瓣切取表浅,易于修薄,是修复足踝大面积软组织缺损的理想皮瓣之一。

Objective To investigate the effectiveness of the lower abdominal conjoined flap with bilateral superficial inferior epigastric arteries(SIEA) for repairing the large soft tissue defects on the foot and ankle.Methods The clinical data of 18 patients with large soft tissue defects on foot and ankle treated between October 2017 and January 2020 were retrospectively analyzed, including 12 males and 6 females;the age ranged from 25 to 62 years,with a median age of 35 years. The causes of injury included machine injury in 9 cases, traffic accident injury in 5 cases,cutting injury in 2 cases, and electric injury in 2 cases. All wounds were accompanied by exposure of blood vessels,tendons, bones, and joints. Wound located at ankle in 8 cases, dorsum of foot in 6 cases, and sole in 4 cases. In the emergency department, complete debridement(the defect area after debridement was 15 cm×10 cm to 25 cm×16 cm) and vacuum sealing drainage on the wound was performed. The time from debridement to flap repair was 3-10 days, with an average of 5 days. According to the defect location and scope, the lower abdominal conjoined flap with bilateral SIEA was prepared. The size of the flap ranged from 15 cm×10 cm to 25 cm×16 cm. The length of vascular pedicle was 4.5-7.5 cm,with an average of 6.0 cm;the thickness of the flap was 0.5-1.2 cm, with an average of 0.8 cm. The abdominal donor site was closed in one-stage. Results One flap was altered as the conjoined flap with the bilateral superficial circumflex iliac artery because of the absence of the SIEA in one side. Except for 1 case of skin flap with distal necrosis, the flap healed after two-stage skin grafting repair;the rest skin flaps survived, and the wounds of the donor and recipient sites all healed by first intention. All patients were followed up 12-28 months, with an average of 16 months. The skin flap had a satisfactory appearance and soft texture, without abnormal hair growth or obvious pigmentation. Only linear scars were left at the donor site, and no complication such as abdominal hernia occurred. The foot and ankle function was satisfactory. At last follow-up, the American Orthopaedic Foot and Ankle Society(AOFAS) scores were rated as excellent in 16 cases and good in 2 cases. Conclusion The lower abdominal conjoined flap with bilateral SIEA is an ideal flap for repairing large defects of foot and ankle with less morbidity scarcely, which ascribed to its ease of dissection, adjustable thinness, and concealed donor site, as well as the flexible perforator match.