预构真皮下薄型皮瓣的实验研究与临床应用

Experiment study and clinical application of the prefabricated subcutaneous thin skin flap

目的:探讨预构知名血管真皮下薄型皮瓣的可行性以及修复皮肤缺损的临床效果。方法:用新西兰大白兔45只,将大白兔耳后动脉静脉预置在颈部皮下,分别在2、3、4、5、6周制成岛状皮瓣,14d内分组进行观察皮瓣成活情况。自2001年1月起,用同样技术,临床应用预置旋股外侧血管降支于大腿内侧真皮下,5周切取该血管为蒂的真皮下薄型皮瓣,游离移植修复手掌、手背、足背等处的皮肤缺损11例。结果:8例皮瓣完全成活,3例皮瓣边缘少许坏死,换药治愈,创面得到满意修复。结论:预构以旋股外侧血管降支的真皮下薄型皮瓣可行,为临床治疗复杂皮肤缺损提供了一种有效修复方法。但预构皮瓣的基础理论及扩大应用有待进一步研究。

Objective: To study the feasibility and the clinical result of the subcutaneous thin skin flap pedicled with prefabricated vessel bundle implantation in the treatment of skin defects. Methods: Forty-five New Zealand rabbits were used in this study. In the animal models, the posterior auricular artery and vein were prefabricated in the cervical subcutaneous part. The island flaps were made at 2, 3, 4, 5, 6 weeks after surgery. The healings of flaps were observed by naked eyes during the next 14 days. As a clinical application, the descending branches of lateral circumflex femoral artery were prefabricated in the medial subcutaneous part of the thigh. Eleven cases with skin defected in the vola, the back of the hand and the instep had been treated with the subcutaneous thin skin flap pedicle with the prefabricated vessel bundle at 5 weeks after surgery since January 2001. Results: Eight cases' flaps survived completely. Necrosis had been seen in the edge of the flaps in 3 cases which were healed after changing the dressing. The outcome was satisfactory. Conclusions: The subcutaneous thin skin flap pedicled with the prefabricated descending branch of lateral circumflex femoral artery was feasible. It offers a repair method for complex skin defects > but the basic theory and the expand application of prefabricated flaps need further research.