摘要
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.
作者
潘勇
朱辉
郑大伟
黎章灿
李甲
张松
杨丹丹
陈步国
PAN Yong;ZHU Hui;ZHENG Dawei;LI Zhangcan;LI Jia;ZHANG Song;YANG Dandan;CHEN Buguo(Department of Hand Surgery,Xuzhou Renci Hospital,Xuzhou,Jiangsu Province 221004,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2023年第2期152-156,共5页
Chinese Journal of Microsurgery
基金
徐州市推动科技创新专项资金重点研发计划(社会发展)(KC21232)。
关键词
腹壁下深动脉穿支皮瓣
上肢
修复
显微外科技术
Deep inferior epigastric artery perforator flap
Upper limb
Repair
Microsurgical technique