浅筋膜浅层和深层切取中小面积股前外侧穿支皮瓣对供区瘢痕的影响

Effect on scar in donor area of small-and medium-sized anterolateral thigh perforator flap harvested from superficial and deep layer of the superficial fascia

目的探讨在浅筋膜浅层平面切取中、小面积ALTPF的可行性,并对比在浅层和深层切取皮瓣对供区瘢痕的影响。方法回顾性分析2020年1月-2021年2月在遵义医科大学附属医院烧伤整形外科收治31例四肢中、小面积软组织缺损的患者,均采用ALTPF修复,创面大小5.0 cm×3.5 cm~17.0 cm×6.0 cm,皮瓣大小6.0 cm×4.0 cm~20.0 cm×6.0 cm,其中皮瓣在浅筋膜浅层平面切取15例(改良组),在浅筋膜深层平面切取16例(传统组)。皮瓣供区均采用"遵义缝合法"直接缝合。随访观察大腿周径差,采用温哥华瘢痕量表(VSS)评估瘢痕外观,并记录瘢痕宽度。两组数据进行统计学分析,P<0.05表示差异有统计学意义。结果皮瓣均顺利成活,创面均Ⅰ期愈合;供区切口术后2~3周均Ⅰ期愈合。患者均获随访,随访时间6~26个月,平均10.7个月。供区创缘无缺血坏死,双侧大腿周径差在改良组[(0.10±0.40)cm]与传统组[(0.03±0.39)cm]差异无统计学意义(t=0.35,P>0.05);改良组较传统组的VSS分值低[两组分别为(2.00±1.46)分和(3.06±1.61)分,t=2.132,P=0.039],瘢痕最宽宽度更小[两组分别为(6.67±3.85)cm和(16.06±6.63)cm),t=2.807,P=0.005],差异均有统计学意义(P<0.05)。结论在浅筋膜浅层平面切取中小面积ALTPF可降低供区瘢痕的宽度,改善修复效果,提高患者满意度。

Objective To compare the effect on scar in donor area of small-and medium-sized anterolateral thigh perforator flap(ALTPF)harvested from superficial and deep layer of the superficial fascia.Methods A retrospective analysis was performed on 31 patients who had small-and medium-sized soft tissue defects in the extremities and admitted to the Department of Burns and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University from January 2020 to February 2021.All the patients were repaired with ALTPFs.The sizes of defect ranged from 5.0 cm×3.5 cm to 17.0 cm×6.0 cm,and the flaps sized from 6.0 cm×4.0 cm to 20.0 cm×6.0 cm.Fifteen ALTPFs were harvested from superficial layer of superficial fascia(modified group),and 16 harvested from deep layer of superficial fascia(traditional group).The flap donor sites were sutured directly using the"Zunyi suture method".Appearance of scars was assessed within the Vancouver Scar Scale(VSS)and in addition the width of scars was been recorded.The data of the 2 groups were statistically analyzed.There was statistically significant difference when P<0.05.Results All flaps were successfully viable.All wounds healed inⅠstage and donor incisions healed inⅠstage at 2-3 weeks after the surgery.All patients entered postoperative follow-up for 6 to 26 months,with a mean of 10.7 months.There was no ischaemic necrosis at the donor margin.There was no significant difference between circumference of thighs between the modified group and traditional group[(0.10±0.40)cm and(0.03±0.39)cm,respectively](P>0.05).VSS were found lower in the modified group(2.00±1.46)than that in the traditional group(3.06±1.61)(t=2.132,P=0.039),as well as the scars were found smaller at the widest point[(6.67±3.85)cm and(16.06±6.63)cm,respectively.t=2.807,P=0.005].The differences were statistically significant(P<0.05).Conclusion Small-and medium-sized ALTPFs,harvested in the superficial layer of superficial fascia,can reduce the width of the donor scar,improve the surgical outcome and increase patient satisfaction.