穿支蒂V-Y推进皮瓣修复老年四肢难愈性溃疡

Refractory ulcer of extremities in the elderly repaired by the V-Y flap advancement based on perforators

目的探讨穿支蒂V-Y推进皮瓣修复老年四肢难愈性溃疡的临床疗效。方法回顾性分析2018年1月—2021年9月上海健康医学院附属崇明医院(新华医院崇明分院)收治的10例老年四肢难愈性溃疡患者临床资料,其中男性6例,女性4例;年龄68~83岁,平均74.0岁。溃疡位于手背3例,足背5例,小腿2例。其中血管性溃疡6例,创伤性溃疡3例,糖尿病足1例。溃疡面积3.5cm×2.0cm~6.0cm×4.0cm。根据穿支血管的解剖基础,结合难愈性溃疡实际情况,设计并切取穿支蒂V-Y推进皮瓣进行修复。皮瓣面积最大为9.0cm×5.0cm,最小为6.0cm×2.5cm。根据皮瓣成活、感染控制、弹性、色泽、外观形态、供区瘢痕、皮肤感觉、住院时间、住院费用、患者认可度等疗效对患者进行综合评价。结果10例皮瓣术后全部顺利成活,其中1例皮瓣远端皮缘发生坏死,给予换药后愈合。术后分别获6~24个月随访,平均8.8个月。疗效评价:满意9例,一般1例。皮瓣肿胀评级,早期:Ⅰ度8例,Ⅱ度2例;后期:Ⅰ度9例,Ⅱ度1例。患者平均住院费用为39762.02元,平均住院时间26.30d。结论穿支蒂V-Y推进皮瓣修复老年四肢难愈性溃疡方法简便、安全可靠、损伤轻、住院费用较低,是修复中、小面积老年四肢难愈性溃疡的理想方法之一,适宜在基层医院中推广。

Objective To discuss the clinical effect of the V-Y flap advancement based on perforators for repairing refractory ulcer of extremities in the elderly.Methods Ten elder patients with refractory ulcer of extremities admitted to Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences(Xinhua Hospital Chongming Branch)from Jan.2018 to Sep.2021 were retrospectively analyzed.There were 6 males and 4 females,their age ranged from 68 to 83 years,with an average age of 74.0 years.The ulcers were located on the dorsum of the hand in 3 cases,on the dorsum of the foot in 5 cases and on the lower leg in 2 cases.Among them,3 cases were traumatic,6 cases were vascular and 1 case was diabetic foot.The sizes of the ulcers ranged from 3.5cm×2.0 cm to 6.0cm×4.0cm.The patients were repaired by the V-Y flap advancement based on perforators.The flaps were designed and dissociated according to the location,size,shape of the ulcer combined with the anatomy of the perforators.The sizes of the flaps ranged from 6.0cm×2.5cm to 9.0cm×5.0cm.The postoperative efficacy was evaluated according to the survival of the flap,infection control,elasticity,color,appearance,scar at the donor site,skin sensation,mean hospitalization time,average expenditure,and patient recognition.Results All the flaps survived,and the incisions in the donor and recipient sites were primarily healed.The appearance,color and elasticity of the flaps were almost same to the normal,at the same time,the scars at the donor sites were small after 6 to 24 months’follow-up.Necrosis appeared in 1 case in the distal edge of the flap and was healed after dressing.The efficacy was satisfactory in 9 cases,and general in 1 case.Degree of flap swelling in early stage was I degree in 8 cases,and II degree in 2 cases;in later stage was I degree in 9 cases,and II degree in 1 case.The mean hospitalization time was 26.30 days,and the average expenditure was 39762.02 Yuan.Conclusion The V-Y flap advancement based on perforators is a simple,safe and reliable method for repairing refractory ulcers of extremities in the elderly,with little damage and low expenditure.It is one of the ideal methods for repairing refractory ulcers in small and medium sizes which is suitable for promotion in basic level hospitals.