旋转皮瓣在会阴部皮肤软组织缺损修复中的应用

Application of rotational skin flap in repairing skin and soft tissue defects in the perineum

目的探讨旋转皮瓣在会阴部皮肤软组织缺损修复中的应用效果。方法回顾性分析2022年1月至2024年3月温州医科大学附属第一医院诊治的9例会阴软组织缺损患者的资料,8例为会阴部Paget′s病广泛切除后软组织缺损,1例为严重尿道狭窄治疗后软组织缺损,缺损面积4 cm×1.5 cm~30 cm×35 cm,均采用旋转皮瓣修复创面,对于面积过大患者采用旋转皮瓣覆盖重要部位结合自体皮肤以及人工皮肤覆盖剩余创面。尿道狭窄患者采用游离口腔黏膜重建尿道结合旋转皮瓣覆盖治疗。供区直接缝合或自体皮肤移植。结果术后9例患者受区皮瓣均存活,供区愈合。随访9~15个月,皮瓣存活良好,皮肤色泽接近正常,供区创面愈合良好。8例Paget′s病患者未见复发,其中1例大面积扩创患者会阴部皮瓣覆盖区域恢复良好,植皮区小范围慢性溃疡形成。尿道狭窄患者皮瓣恢复可,阴茎外形良好,未见尿道狭窄、尿瘘、窦道等。结论旋转皮瓣在会阴部软组织缺损中治疗效果明确,适用于会阴部皮肤软组织缺损修复。

Objective To explore the application effect of rotating skin flap in the repair of skin and soft tissue defects in the perineum.Methods A retrospective analysis was conducted on the data of 9 patients with perineal soft tissue defects treated in the Department of the First Affiliated Hospital,Wenzhou Medical University from January 2022 to March 2024.Among them,8 cases were soft tissue defects after extensive resection of Paget′s disease in the perineum,and 1 case was soft tissue defects after treatment of severe urethral stricture.The defect area ranged from 4 cm×1.5 cm to 30 cm×35 cm,and all wounds were repaired with rotating skin flaps,For patients with excessive area,rotating skin flaps were used to cover important areas,combined with autologous skin and artificial skin to cover the remaining wounds.Patients with urethral stricture were treated with free oral mucosal reconstruction of the urethra combined with rotational skin flap coverage.The donor site was directly sutured or autologous skin was transplanted.Results After surgery,the recipient skin flaps of 9 patients survived and the donor area healed.After a follow-up of 9-15 months,the skin flap survived well,with skin color approaching normal,and the donor site wound healed well.Eight patients with Paget′s disease did not show any recurrence,among which one patient with extensive wound expansion had good recovery of the perineal skin flap coverage area,and small-scale chronic ulcers appeared in the skin graft area.The skin flap of the patient with urethral stricture had recovered well,and the shape of the penis was good,without any urethral stricture,urinary fistula,sinus tract,etc.Conclusions The rotational skin flap has a clear therapeutic effect on perineal soft tissue defects and is suitable for repairing perineal skin and soft tissue defects.