带蒂大网膜瓣移植修复脑起搏器置入后继发排异创面的临床效果

Clinical effects of pedicled omental flap transplantation in repairing secondary rejection wounds after brain pacemaker implantation

目的探讨采用带蒂大网膜瓣移植修复脑起搏器置入后继发排异创面的临床效果。方法采用回顾性观察性研究方法。2021年1—8月,上海交通大学医学院附属瑞金医院创面修复中心收治5例(男3例、女2例,年龄56~69岁)符合入选标准的置入脑起搏器后继发排异创面的患者,排异创面单纯位于胸前脉冲发生器置入部位者2例、单纯位于耳后导线与电极连接部位者2例、位于胸前+耳后者1例。所有排异创面均采用带蒂大网膜瓣移植修复。清创后创面面积为2~15 cm^(2)。术后,观察创面愈合情况以及相关并发症(疼痛、感染、切口疝、大网膜瓣坏死等)发生情况。随访时,观察创面有无复发情况。结果5例患者创面均于术后2周内愈合,且未出现相关并发症。随访12~18个月,1例患者左侧耳后的排异创面在术后4个月复发,最终选择移除起搏器;其余4例患者创面无复发。结论采用带蒂大网膜瓣移植修复脑起搏器置入后的继发排异创面安全有效,术后并发症少。

Objective To explore the clinical effects of pedicled omental flap transplantation in repairing secondary rejection wounds after brain pacemaker implantation.Methods A retrospective observational study was conducted.From January to August 2021,5 patients with secondary rejection wounds after brain pacemaker implantation who met the inclusion criteria were admitted to the Wound Repair Center of Ruijin Hospital of Shanghai Jiao Tong University School of Medicine,including 3 males and 2 females,aged 56-69 years,with the wound developed at the pulse generator implantation site in the chest in 2 cases,at the connection site of the wire and electrode behind the ear in 2 cases,and at both the chest and the back of the ear in 1 case.All the wounds were repaired by pedicled omental flap transplantation.The wound area after debridement was 2-15 cm^(2).After operation,the wound healing and related complications(pain,infection,incisional hernia,omental flap necrosis,etc.)were observed.During follow-up,the recurrence of the wound was observed.Results The wounds of all 5 patients healed within 2 weeks after operation,without related complications.During follow up of 12-18 months,1 patient got a recurrence of rejection wound behind the left ear 4 months after surgery and eventually had the brain pacemaker removed;the other 4 patients had no recurrence of wounds.Conclusions Pedicled omental flap transplantation can repair the secondary rejection wounds after brain pacemaker implantation safely and effectively,with few postoperative complications.