不同动脉吻合方式的游离旋髂浅动脉穿支皮瓣移植修复四肢皮肤软组织缺损

Free superficial iliac circumflex artery perforator flap with different arterial anastomosis methods for repairing soft tissue defects of limbs

目的探讨不同动脉吻合方式的游离旋髂浅动脉穿支皮瓣移植修复四肢皮肤软组织缺损的临床疗效。方法采用回顾性队列研究分析2017年3月至2020年3月宁波市第六医院收治的60例四肢皮肤软组织缺损患者临床资料,其中男38例,女22例;年龄21~57岁[(35.6±3.1)岁]。缺损部位:上肢33例,下肢27例。缺损面积为4.5 cm×2.0 cm~17.0 cm×8.0 cm。所有患者Ⅰ期予清创、负压封闭引流(VSD),Ⅱ期行游离旋髂浅动脉穿支皮瓣移植修复,皮瓣面积4.9 cm×2.6 cm~17.0 cm×8.0 cm。按不同吻合血管方式,其中旋髂浅动脉与桡动脉端侧吻合25例,尺动脉8例,足背动脉18例,胫前动脉9例。记录皮瓣成活情况、愈合时间。末次随访时观察患者皮瓣质地及外观。供区外观采用温哥华瘢痕评分(VSS)评价,受区外观采用数字评分法评估患者满意度。结果患者均获随访5~15个月[(7.1±1.3)个月]。术后所有皮瓣顺利成活,其中4例出现动脉危象,包括2例皮瓣穿支与桡动脉吻合,1例为尺动脉,1例为足背动脉。不同受区行端侧吻合动脉术后皮瓣危象发生差异无统计学意义(P均>0.05)。皮瓣血管蒂与桡动脉、尺动脉、足背动脉、胫前动脉吻合的患者皮瓣愈合时间分别为15(14,16)d、15(14,16)d、14.5(14,16)d、14(14,15.5)d(P均>0.05)。末次随访时患者皮瓣弹性充足,质地柔软。末次随访时皮瓣血管蒂与桡动脉、尺动脉、足背动脉、胫前动脉吻合的患者供区VSS分别为(10.2±1.5)分、(10.9±1.6)分、(9.4±1.5)分、(9.8±1.5)分(P均>0.05)。所有患者对受区创面外观满意,末次随访时皮瓣血管蒂与桡动脉、尺动脉、足背动脉、胫前动脉吻合的患者满意度分别为9(8,10)分、9(8,9)分、9(8,9)分、8(8,9.5)分(P均>0.05)。结论不同动脉吻合方式的游离旋髂浅动脉穿支皮瓣移植修复四肢皮肤软组织缺损安全可靠,术后发生血管危象少,皮瓣成活良好,愈合不受血管吻合方式的影响,供区隐蔽、瘢痕小,且受区外观满意,可以作为游离组织瓣移植的常用血管修复方式之一。

Objective To investigate the clinical effect of free superficial iliac circumflex artery perforator flap with different arterial anastomosis methods for repairing soft tissue defects of limbs.Methods A retrospective cohort study was used to analyze the data of 60 patients with soft tissue defects of limbs treated in Ningbo No.6 Hospital from March 2017 to March 2020,including 38 males and 22 females,aged 21-57 years[(35.6±3.1)years].The wounds were located on the upper limb in 33 patients and the lower limb wound in 27 patients.The defect area was 4.5 cm×2.0 cm-17.0 cm×8.0 cm.All patients received debridement and vacuum sealing drainage(VSD)in stage I,and free superficial iliac circumflex artery perforator flap transplantation in stage II.The flap area was 4.9 cm×2.6 cm-17.0 cm×8.0 cm.According to the different anastomotic vessels,the superficial iliac circumflex artery was anastomosed end-to-side to the radial artery in 25 patients,the ulnar artery in 8,the dorsalis pedis artery in 18 and the anterior tibial artery in 9.Flap healing and healing time were detected.Texture and appearance of the flap were observed at the last follow-up.The appearance of the donor area was evaluated by Vancouver scar scale(VSS),and the satisfaction rate of appearance of the recipient area was measured by numerical score.Results All patients were followed up for 5-15 months[(7.1±1.3)points].All flaps survived successfully after operation,including arterial crisis in 4 patients,among which 2 had flap perforator anastomosed with the radial artery,1 with the ulnar artery and 1 with the dorsalis pedis artery.There was no significant difference in flap crisis after end-to-side arterial anastomosis in different recipient areas(P>0.05).For patients with flap perforator anastomosed with the radial artery,the ulnar artery,the dorsalis pedis artery and the anterior tibial artery,the flap healing time was 15(14,16)days,15(14,16)days,14.5(14,16)days and 14(14,15.5)days,respectively(all P>0.05).The flaps showed sufficient elasticity and soft texture at the last follow-up.For patients with flap perforator anastomosed with the radial artery,the ulnar artery,the dorsalis pedis artery and the anterior tibial artery,the VSS of the donor area was(10.2±1.5)points,(10.9±1.6)points,(9.4±1.5)points and(9.8±1.5)points at the last follow-up(all P>0.05),and the satisfaction rate of appearance of the recipient area was 9(8,10)points,9(8,9)points,9(8,9)points and 8(8,9.5)points at the last follow-up(P>0.05),showing that all patients were satisfied with the appearance of the wound.Conclusions The transplantation of free superficial iliac circumflex artery perforator flap with different arterial anastomosis methods is safe and reliable in repairing soft tissue defects of limbs with advantages of low occurrence of postoperative vascular crisis,good flap survival,no influence on flap healing by different anastomotic vessels,hidden donor area with small scar and satisfactory appearance of the recipient area.It can be used as one of the common vascular repair methods for free tissue flap transplantation.