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拱顶石穿支皮瓣修复小型创面

Repair of small wounds with keystone design perforator island flap
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摘要 [目的]介绍拱顶石穿支皮瓣修复小型创面的手术与治疗技术和初步临床效果。[方法] 2014年1月—2020年12月对26例小腿与足踝部小型创面患者行拱顶石穿支皮瓣修复术。修整创面为椭圆形,其长轴平行于肢体的纵轴,在创面的一侧设计拱顶石皮瓣,短底边为创面的弧形边缘,长底边与短底边平行,保持皮瓣宽度与创面最大宽度比例为1∶1~1.5∶1。沿设计线切开皮瓣边缘,分离皮肤及筋膜组织,推移皮瓣至创面并逐层缝合,供区直接缝合或植皮。[结果]所有患者均顺利完成手术,皮瓣受区与供区均愈合良好,愈合时间平均(15.3±6.4) d。随访时间平均(22.9±6.3)个月。皮瓣改良Highet感觉评级S0/S1/S2/S3/>S3由出院前的(2/8/10/3/3)例显著改善为末次随访时的(0/2/3/6/15)例(P<0.05)。VAS评分由出院前(4.6±1.9)分显著减少为末次随访时(0.8±0.4)分(P<0.05)。AOFAS评分优良率为92.3%。[结论]拱顶石穿支皮瓣能够较好地满足外观和功能需求,是小腿与足踝部小型创面的有效修复方式。 [Objective] To introduce the surgical techniques and preliminary clinical results of keystone design perforator island flap(KDPIF) for repairing small wounds. [Methods] A total of 26 patients were treated with KDPIF for small wounds in the lower leg or foot and ankle. After debridement, the wound was trimmed to an oval shape with long axis parallel to the longitudinal axis of the limb. The flap was designed on one side of the wound, with short bottom edge of the curved wound edge and the long bottom edge parallel to the short bottom edge maintaining a ratio of 1∶1 to 1.5∶1 between the width of the flap and the maximum width of the wound. Cut the edge of the skin flap along the design line, separate the skin and fascia tissue, push the skin flap to the wound and suture in layers, finally, close donor area by direct suture. [Results] All patients were successfully operated on without serious complications, and got the flaps survived well, despite the fact that there were 4 cases of flap swelling, 1 case of flap edge necrosis, 3 cases of incision dehiscence, and 2 cases of pain deficiency in the early stage. All patients were followed up for 12 to 30 months, with an average of(22.9±6.3) months. At the last follow-up, the texture and color of the flap were similar to the surrounding tissue. In addition, the sensory grade of the flap was significantly improved from S0/S1/S2/S3/>S3(2/8/10/3/3) before discharge to(0/2/3/6/15) at the latest follow up(P<0.05), while the VAS score was significantly reduced from(4.6±1.9) to(0.8±0.4) accordingly(P<0.05). According to the AOFAS score, 14 cases were excellent and 10 cases were good, with an excellent and good rate of 92.3%. [Conclusion] This keystone design perforator island flap can better meet the appearance and function requirements, and is an effective way to repair small wounds in the lower leg or foot and ankle.
作者 付炳金 朱晓东 杜瑞 邓明明 孔德海 薛阳 尹刚 FU Bing-jin;ZHU Xiao-dong;DU Rui;DENG Ming-ming;KONG De-hai;XUE Yang;YIN Gang(Department of Foot and Ankle Surgery,The Affiliated Hospital,Binzhou Medical University,Binzhou 256600,China)
出处 《中国矫形外科杂志》 CAS CSCD 北大核心 2024年第8期759-763,共5页 Orthopedic Journal of China
关键词 拱顶石皮瓣 软组织缺损 难治性创面 创面修复 keystone design perforator island flap soft tissue defect refractory wound wound repair
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