改良股前外、腹壁下穿支皮瓣修复四肢创面的临床应用

Clinical application of modified anterolateral thigh and deep ingerior epigastric perforator flap for wound repair

目的探讨改良股前外、腹壁下穿支皮瓣修复四肢创面的临床应用。方法2020年9月-2021年11月收治四肢创面患者39例,采用改良股前外侧动脉降支穿支皮瓣及腹壁下动脉穿支皮瓣修复。皮瓣切取面积:3.8 cm×8.8 cm~23.0 cm×26.0 cm,1例皮瓣供区二期间断缝合,其余皮瓣供区直接间断皮内缝合。观察皮瓣成活情况,随访供受区瘢痕增生情况,上肢采用中华医学会手外科学会上肢部分功能评定试用标准评定手功能,下肢采用永久性残损评定指南评定标准评定下肢功能。结果39例皮瓣全部成活。随访3~12个月,皮瓣质地及弹性、外形恢复较佳,供区均无皮肤坏死,形成线性瘢痕,存在轻度色素沉着,无感觉异常。全组皮瓣两点辨别觉0.4~1.2 cm;手功能评定:优30例,良2例,中1例,下肢功能评定:优5例,良1例。结论改良穿支皮瓣修复四肢创面血运可靠,手术操作简便、安全、疗程短,值得临床推广。

Objective To investigate the clinical application of modified anterolateral thigh and deep ingerior epigastric perforator flap for wound repair.Methods From September 2020 to November 2021,39 patients were admitted.The modified anterolateral perforator flap and deep inferior epigastal artery perforator flap were used to repair the wound.The flap cut-out resection area was 3.8 cm×8.8 cm^(2)3.0 cm×26.0 cm.The flap donor site of 1 patient was sutured in the second stage,and the other patients were sutured directly in the donor site The survival of the flap was observed,and the scar hyperplasia of the donor and recipient area was followed up.The hand function of the upper limb was assessed by the trial standard of the Upper limb function assessment of Chinese Medical Association Hand Surgery Society,and the lower limb function was assessed by the standard guide for the Permanent Impairment Assessment of the lower limb.Results The skin flaps of all 39 patients were followed up for 3 to 12 months.The texture and elastic shape of the flaps recovered well,and there was no skin necrosis,linear scar,pigmentation and paresthesia at the donor site.In this group of patients,the two-point discrimination was 0.4~1.2 cm,the hand function assessment was excellent in 30 cases,good in 2 cases,medium in 1 case,and the lower limb function assessment was excellent in 5 cases,good in 1 case.Conclusion The modified perforator flap can be used to repair the blood flow of limb wounds,and the operation is simple,safe and the course of treatment is short,which is worthy of clinical promotion.