双蒂腹壁下动脉穿支皮瓣修复下肢大面积软组织缺损的疗效

Curative effects of bi-pedicled deep inferior epigastric perforator flap in repairing large soft tissue defects in the lower limbs

目的探讨双蒂腹壁下动脉穿支皮瓣修复下肢大面积软组织缺损的疗效。方法采用回顾性观察性研究方法。2016年2月—2020年6月,西南医科大学附属中医医院手外科收治因外伤所致或肿瘤/瘢痕切除后下肢大面积软组织缺损患者16例,其中男9例、女7例,年龄25~58岁,软组织缺损面积为14.0 cm×8.0 cm~32.0 cm×18.0 cm。以腹部为供区,设计并切取腹壁联体皮瓣——携带两侧腹壁下动脉主干的双蒂腹壁下动脉穿支皮瓣(面积为15.0 cm×9.0 cm~32.0 cm×20.0 cm)修复创面。将供区创面直接缝合。术后观察皮瓣成活情况、供受区创面愈合情况,随访评估疗效,末次随访时分别根据美国膝关节协会评分与下肢功能量表评估膝关节和小腿功能。结果15例患者术后皮瓣成活;1例患者术后皮瓣边缘部分感染,经清创换药后愈合。16例患者供受区创面均愈合良好。随访16~28个月显示,受区外形较好,质地柔软,未出现明显外观臃肿、色素明显沉着或异常毛发生长等;供区仅遗留线性瘢痕,未出现腹壁疝或瘢痕增生等并发症;膝关节及小腿功能重建较好,未见肿瘤复发。末次随访时,4例膝关节损伤患者膝关节功能评估中,优者3例、良者1例;12例小腿损伤患者小腿功能评估中,优者9例、良者3例。结论双蒂腹壁下动脉穿支皮瓣供区隐蔽、组织量丰富、切取面积大,用其修复下肢大面积软组织缺损可获得较佳的近期外观与功能恢复效果。

Objective To investigate the curative effects of bi-pedicled deep inferior epigastric perforator(DIEP)flap in repairing large soft tissue defects in the lower limbs.Methods A retrospective observational study was conducted.From February 2016 to June 2020,16 patients with large soft tissue defects in the lower limbs caused by trauma or after tumor/scar resection were admitted to the Department of Hand Surgery of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,including 9 males and 7 females,aged 25-58 years,with the area of soft tissue defects ranging from 14.0 cm×8.0 cm to 32.0 cm×18.0 cm.Using the abdomen as the donor site,the conjoined abdominal wall flap,i.e.,the bi-pedicled DIEP flap(with an area ranging from 15.0 cm×9.0 cm to 32.0 cm×20.0 cm)carrying two sets of the trunk of the deep inferior epigastric artery was designed and resected to repair the wound.The donor site wound was sutured directly.The flap survival and wound healing in the donor and recipient areas were observed after operation.The curative effect was evaluated during the follow-up.At the last follow-up,the American Knee Society score and lower extremity functional scale were used to assess the functions of knee joint and lower limb,respectively.Results The flaps of 15 patients survived after operation;the flap of one patient had partial infection at the edge after operation but healed after debridement and dressing change.The wounds in the donor and recipient areas of 16 patients all healed well.Follow-up of 16-28 months showed that the recipient area had a good shape and pliable texture,and there was no obvious swollen appearance,hyperpigmentation,or abnormal hair growth;the donor site had linear scar only,with no complications such as abdominal hernia or hyperplastic scar;the functions of knee joint and lower limb were well reconstructed,with no recurrence of tumor.At the last follow-up,among the 4 patients with knee joint injury,3 cases were excellent and 1 case was good in the evaluation of knee joint function;among the 12 patients with lower limb injury,9 cases were excellent and 3 cases were good in the evaluation of lower limb function.Conclusions The donor site of bi-pedicled DIEP flap is concealed with abundant tissue and large area for resection,with which can be used to repair large soft tissue defects in the lower limbs,achieving good short-term results of appearance and function restoration.