游离旋髂浅动脉浅支穿支皮瓣联合皮瓣供区以远全厚皮片修复四肢较大创面的临床效果

Clinical effects of free superficial circumflex iliac artery superficial branch perforator flap combined with full-thickness skin graft far from the flap donor site in repairing the large wounds in extremities

目的探讨游离旋髂浅动脉(SCIA)浅支穿支皮瓣联合皮瓣供区以远全厚皮片修复四肢较大创面的临床效果。方法该研究为回顾性观察性研究。2020年1月—2022年6月,蚌埠医学院第一附属医院收治19例符合入选标准的四肢较大创面患者,其中男15例、女4例,年龄28~75岁。Ⅰ期行清创、骨折复位固定、肌腱血管神经修复和负压封闭引流。Ⅱ期清创后,创面总面积为13.0 cm×8.0 cm~34.0 cm×15.0 cm。采用SCIA浅支穿支皮瓣(面积为10.0 cm×6.5 cm~15.0 cm×8.0 cm)修复肌腱、骨外露处创面(面积为9.0 cm×6.0 cm~14.0 cm×7.0 cm),采用皮瓣供区以远全厚皮片(面积为5.0 cm×3.5 cm~13.0 cm×8.0 cm)修复肉芽组织生长良好创面(面积为5.0 cm×3.5 cm~13.0 cm×8.0 cm)。供区创面均经拉拢缝合。记录患者手术时间、手术出血量,术后观察皮瓣和皮片成活情况。随访观察皮瓣和皮片情况、供区瘢痕情况及其对供区功能的影响。末次随访时,采用疗效满意度评分表评价患者对疗效的满意度。结果患者手术时间为2.0~3.5 h,手术出血量为100~320 mL。1例患者术后第2天皮瓣边缘出现瘀斑、静脉危象,经探查后皮瓣成活;其余患者皮瓣均顺利成活。患者皮片均顺利成活。2例患者因后期肥胖导致皮瓣臃肿,术后6个月行皮瓣削薄手术后达到预期效果。随访6~24个月,皮瓣均弹性好、质地软,皮片无磨损、破溃,供区均遗留线性瘢痕但功能未受到影响,患者对疗效均表示满意。结论采用游离SCIA浅支穿支皮瓣联合皮瓣供区以远全厚皮片修复四肢较大创面,安全可靠、创伤小、手术时间短、术后供受区外形和功能良好。

Objective To investigate the clinical effects of free superficial circumflex iliac artery(SCIA)superficial branch perforator flap combined with full-thickness skin graft far from the flap donor site in repairing the large wounds in extremities.Methods The study was a retrospective observational study.From January 2020 to June 2022,19 patients with large wounds in extremities who met the inclusion criteria were admitted to the First Affiliated Hospital of Bengbu Medical College,including 15 males and 4 females,aged 28-75 years.The debridement,fracture reduction and fixation,tendon,vessel,and nerve repair,and vacuum sealing drainage were performed in the first stage surgery.After debridement in the second stage surgery,the total wound area was 13.0 cm×8.0 cm-34.0 cm×15.0 cm.The tendon and bone exposed wound with area of 9.0 cm×6.0 cm-14.0 cm×7.0 cm was repaired with free SCIA superficial branch perforator flap with area of 10.0 cm×6.5 cm-15.0 cm×8.0 cm.The remaining granulation tissue wound with area of 5.0 cm×3.5 cm-13.0 cm×8.0 cm was repaired with full-thickness skin graft far from the flap donor site with area of 5.0 cm×3.5 cm-13.0 cm×8.0 cm.All the wounds in donor site were sutured.The operation time and amount of bleeding of patients during the surgery were recorded,the survival of flap and skin graft were observed after surgery.During follow-up,the flap and skin graft,scar in the donor site and its effect on donor site function were observed.At the last follow-up,the satisfaction of patients with the efficacy was evaluated by the efficacy satisfaction rating score.Results The operation time of patients was 2.0-3.5 h.The amount of bleeding of patients during the surgery was 100-320 mL.One patient had ecchymosis and venous crisis in the edge of flap on the second day after surgery,and the flap survived after exploration.The flaps of the other patients survived smoothly.The skin grafts of patients all survived smoothly.Two patients had bloated flaps due to obesity in the later stage,and the expected results were achieved after flap thinning surgery 6 months after operation.During the follow-up of 6 to 24 months,the flaps had good elasticity and soft texture,and the skin grafts had no wear or ulceration;linear scars were left in all the donor sites but their functions were not affected.The patients were all satisfied with the efficacy.Conclusions Free SCIA superficial perforator flap combined with full-thickness skin graft far from the donor site was used to repair the large wounds in extremities,which was safe,reliable,and less traumatic and short in operation time,and resulted in good postoperative appearance and function in the donor sites and recipient sites.