游离分叶穿支皮瓣修复四肢复杂创面

Repair of complex wounds of limbs with free lobed perforator flaps

目的探讨游离分叶穿支皮瓣修复四肢复杂创面的疗效。方法2018年1月—2021年1月,收治10例四肢复杂创面患者。男7例,女3例;年龄32~64岁,平均45岁。致伤原因:交通事故伤4例,机器绞伤3例,机器挤压伤1例,重物压砸伤2例。上肢创面5例,下肢创面5例。创面范围11 cm×10 cm~25 cm×18 cm。采用旋股外侧动脉降支穿支三叶皮瓣7例、四叶皮瓣2例,旋股外侧动脉降支联合斜支穿支三叶皮瓣1例。皮瓣切取范围12.0 cm×10.5 cm~28.0 cm×12.0 cm。供区直接缝合9例,接力旋髂浅动脉穿支皮瓣修复1例。结果术后1例皮瓣边缘窦道形成,经换药、引流后愈合;其余皮瓣均顺利成活,创面Ⅰ期愈合。供区皮瓣成活,切口均Ⅰ期愈合。患者均获随访,随访时间6~24个月,平均11个月。皮瓣无明显臃肿,色泽、质地良好。供区仅遗留线性瘢痕。结论游离分叶穿支皮瓣能有效修复四肢复杂创面,术后皮瓣成活率高,并发症少。

Objective To explore the effectiveness of free lobed perforator flaps in repairing of complex wounds of limbs.Methods Between January 2018 and January 2021,10 patients with complex wounds of limbs were admitted.There were 7 males and 3 females,aged from 32 to 64 years,with an average age of 45 years.There were 4 cases of traffic accident injuries,3 cases of machine strangulation injuries,1 case of machine crush injury,and 2 cases of heavy object crush injuries.There were 5 cases of upper limb wounds and 5 cases of lower limb wounds.The size of wounds ranged from 11 cm×10 cm to 25 cm×18 cm.The wounds were repaired with tri-lobed flaps of the descending branch of the lateral femoral circumflex artery in 7 cases,four-lobed flaps in 2 cases,and with tri-lobed flaps of the descending branch of the lateral femoral circumflex artery combined with oblique branch in 1 case.The size of flaps ranged from 12.0 cm×10.5 cm to 28.0 cm×12.0 cm.The donor sites were sutured directly in 9 cases and repaired with superficial iliac circumflex artery perforator flap in 1 case.Results Sinus formed at the edge of the flap in 1 patient,which healed after dressing change and drainage;other flaps survived well,and the wounds healed by first intention.The skin flap at donor site survived,and the incisions healed by first intention.All patients were followed up 6-24 months(mean,11 months).All flaps had good appearance and function,and linear scars were left at the donor site without obvious complications.Conclusion Free lobed perforator flap is an alternative method to repair complex wounds of limbs with high safety,good effectiveness,and less complications.