游离腹壁下深动脉穿支皮瓣修复上肢较大创面的临床效果

Clinical efficacy of free deep inferior epigastric artery perforator flap in repair of large wounds in upper limb

目的总结应用游离腹壁下深动脉穿支皮瓣(DIEPF)修复上肢较大创面的临床疗效。方法回顾性分析2016年6月至2022年3月徐州仁慈医院手外科应用游离DIEPF修复肘部、前臂、手腕部较大创面9例,其中男3例,女6例,年龄36~65(平均50)岁;创面面积6.0 cm×7.0 cm~25.0 cm×33.0 cm,其中合并桡、尺骨骨折7例,腕骨骨折4例,掌骨骨折4例,肱骨骨折1例,均有不同程度肌腱、血管和神经损伤。共切取10块皮瓣,皮瓣切取面积7.0 cm×8.0 cm~12.0 cm×35.0 cm,吻合单侧血管蒂6例7块皮瓣,吻合双侧血管蒂3块皮瓣,动脉端端吻合1块皮瓣,端侧吻合8例9块皮瓣,静脉均为端端吻合。腹部供区行脐重建3例,所有供区创面均一期闭合。术后定期门诊、微信随访。结果8例9块皮瓣顺利成活,1例1块皮瓣远端部分皮肤坏死,经植皮修复愈合。术后随访6~60个月,平均12个月,所有皮瓣末次随访时皮瓣色泽与周围皮肤相近,轻度臃肿,质地柔软,5例皮瓣感觉恢复至S2,另外4例皮瓣感觉未测出。结论DIEPF穿支相对恒定,可供切取面积大,供区创面可一期闭合,适合上肢较大创面修复使用。

ObjectiveTo summarise the clinical efficacy of free deep inferior epigastric artery perforator flap(DIEPF)in repairing large wounds in upper limb.MethodsFrom June 2016 to March 2022,free DIEPF repair surgery were performed for 9 cases with large defects in elbow,forearm and wrist in the Department of Hand Surgery,Xuzhou Renci Hospital.The patients were 3 males and 6 females at 36-65(average 50)years old.The sizes of defect ranged from 6.0 cm×7.0 cm to 25.0 cm×33.0 cm.Seven defects combined with radius-ulnar fracture,4 with wrist fracture,4 with metacarpal fracture and 1 with humerus fracture.All defects had various degrees of injuries of tendon,blood vessel and nerve.A total of 10 flaps were harvested,and the size of flaps were 7.0 cm×8.0 cm-12.0 cm×35.0 cm.Vessels in 7 flaps of 6 patients were anastomosed with unilateral vascular pedicles and 3 with bilateral vascular pedicles.End-to-end arterial anastomosis was performed on 1 flap,and the other 9 flaps of 8 patients had end-to-side arterial anastomoses.End-to-end vein anastomoses were performed on all flaps.Umbilical reconstruction was performed at the abdominal donor site for 3 patients,and all donor site wounds were closed in stage I surgery.Scheduled outpatient and WeChat follow-up were made after surgery.ResultsNine flaps in 8 patients survived successfully.Partial skin necrosis occurred in 1 flap and repaired by skin grafting.Follow-up lasted for 6 to 60 months(12 months in average).At the last follow-up,the colour of the flaps was found being similar to the surrounding skin with mildly bloated and soft in texture.Sensation of the flaps recovered to S2 in 5 patients,and not detected in 4 cases.ConclusionThe free DIEPF has a relatively constant perforator and the flap can be used for repairing a large area of defect.The donor site wound can be closed inⅠstage surgery.Free DIEPF is suitable for repair of large upper limb wounds.