腹前外侧壁穿支皮瓣修复下肢大面积组织缺损的临床研究

Clinical study on repairing large tissue defect of lower limbs with the perforator flaps in anterolateral wall abdominal

目的探讨腹前外侧壁穿支皮瓣修复下肢大面积组织缺损的临床效果。方法2017年1月~2020年12月对13例下肢大面积皮肤和软组织缺损的患者采用腹前外侧壁穿支皮瓣手术进行修复,创面缺损面积为8.0 cm×5.0 cm~20.0 cm×17.0 cm,皮瓣切取面积6.0 cm×9.0 cm~18.0 cm×21.0 cm;皮瓣供区均直接分层缝合。术后观察创面闭合、皮瓣成活与供区愈合情况,定期随访皮瓣外观、质地、肢体功能恢复情况。结果本组12例皮瓣顺利成活,皮瓣色泽与周围正常皮肤接近,皮瓣外形基本满意;1例腹壁下动脉穿支皮瓣游离移植患者术后皮瓣发生静脉危象,手术探查吻合静脉后皮瓣成活,边缘坏死1.5 cm,换药处理后愈合;全部患者创面受区与腹壁供区创口Ⅰ期愈合。8例患者患肢功能活动良好,5例皮瓣位于关节部位长期制动因而关节活动部分受限。结论腹前外侧壁穿支皮瓣具有皮瓣供区血供来源稳定,供区位置隐蔽、可提供较大面积皮肤和组织等优点,对于修复下肢大面积组织缺损疗效可靠。

Objectives To investigate the clinical effect of the extended perforator flaps in anterolateral wall abdominal in repairing large tissue defects of lower limbs.Methods From January 2017 to December 2020,13 patients with large skin and soft tissue defects of lower limbs were repaired with the extended perforator flaps in anterolateral wall abdominal.The defect area of the wound was 5.0 cm×8.0 cm~17.0 cm×20.0 cm,and the cut area of the flap was 6.0 cm×9.0 cm-18.0 cm×21.0 cm.The donor area of the skin flap was sutured directly.The wound closure,flap survival and donor site healing were observed after operation.The appearance,texture of the flap and the affected limb function were followed up regularly.Results In this group,12 cases of flaps survived successfully.The color of flaps was close to the surrounding normal skin,and the appearance of flaps was basically satisfactory.One case of venous crisis occurred after inferior epigastric artery perforator flap surgery,and survived after exploratory surgery with the necrosis in the distal part of the flap,which healed after dressing.The other flaps healed well and the color of the flaps was normal.Both recipient site and donor site healed in primary union.Among this group,8 patients had good limb function,and 5 patients had joint dysfunction due to long-term immobilization and restrict by the flaps.Conclusions The extended perforator flaps in anterolateral wall abdominal has the advantages of stable blood supply,concealed location and large amount of skin and tissue in the donor area,it is reliable in repairing large tissue defects of lower extremities.