摘要
目的探讨股前外侧血流桥接嵌合穿支皮瓣游离移植治疗伴主干动脉缺损的上肢复合组织缺损的临床效果。方法该研究为回顾性观察性研究。2019年5月—2022年1月,宁夏医科大学总医院手足踝外科收治11例符合入选标准的伴主干动脉缺损的上肢复合组织缺损患者,其中男7例、女4例,年龄18~56岁。清创后,皮肤软组织缺损面积为20 cm×6 cm~32 cm×10 cm,无效腔或深部组织裸露面积为7 cm×4 cm~10 cm×7 cm。3例患者桡动脉缺损,长度为4~7 cm;2例患者尺动脉缺损,长度为5~8 cm;4例患者尺、桡动脉均缺损,长度为3~7 cm;2例患者尺、桡动脉及肱动脉均缺损,长度为4~8 cm。设计并切取股前外侧血流桥接嵌合穿支皮瓣,切取皮瓣面积为22 cm×7 cm~32 cm×11 cm、嵌合肌瓣面积为7 cm×4 cm~10 cm×7 cm,“T”形血管蒂中桥接血管的长度为4~8 cm。移植皮瓣时,将血管蒂近端同受区血管近端吻合、血管蒂远端同前臂远端较正常的血管吻合,利用肌瓣填塞无效腔。对组织瓣供区创面采用直接闭合或移植皮片处理。术后,观察皮瓣血运及成活情况、远端肢体成活情况、移植皮片成活情况。术后2~4周,行CT血管造影(CTA)检查,观察吻合动脉近远端的通畅情况。随访时观察皮瓣质地、供区创面愈合情况。结果1例患者(前臂完全离断)于术后第5天出现肢体远端血运障碍,CTA检查提示桥接的动脉和皮瓣远端吻合口动脉均栓塞,急诊探查显示远端肢体肌肉及皮肤软组织坏死较多,遂行截肢术;其余10例患者皮瓣均未发生血管危象且全部成活,远端肢体全部成活,供区移植皮片成活良好。术后2~4周,吻合的动脉近远端通畅情况良好。随访11~37个月,皮瓣质地良好,所有供区创面愈合良好。结论运用股前外侧血流桥接嵌合穿支皮瓣修复伴主干动脉缺损的上肢复合组织缺损可提高保肢成功率,值得在临床推广。
Objective To investigate the clinical effect of anterolateral thigh flow-through chimeric perforator free flap transplantation in the treatment of upper limb complex tissue defects with main artery injury.Methods The study was a retrospective observational study.From May 2019 to January 2022,11 patients with upper limb complex tissue defects combined with main artery injury who met the inclusion criteria were admitted to the Department of Hand,Foot and Ankle Surgery of General Hospital of Ningxia Medical University,including 7 males and 4 females,aged from 18 to 56 years.After debridement,the area of skin and soft tissue defects was from 20 cm×6 cm to 32 cm×10 cm,and the exposed area of dead cavity or deep tissue was from 7 cm×4 cm to 10 cm×7 cm.Three patients had radial artery defects with a length of 4 to 7 cm;two patients had ulnar artery defects with a length of 5 to 8 cm;4 patients had defects in both ulnar and radial arteries with a length of 3 to 7 cm;and in two patients,the ulnar,radial and brachial arteries were all defective with a length of 4 to 8 cm.The anterolateral thigh flow-through chimeric perforator flap was designed and cut.The skin flap area was from 22 cm×7 cm to 32 cm×11 cm,the chimeric muscle flap area was from 7 cm×4 cm to 10 cm×7 cm,and the length of the flow-through vessel in the"T"shaped vessel pedicle was from 4 to 8 cm.When transplanting the skin flap,the proximal end of the vascular pedicle was anastomosed with the proximal end of the recipient site,and the distal end of the vascular pedicle was anastomosed with the more normal blood vessel at the distal end of the forearm;the invalid cavity was filled with the muscle flap.The donor site wounds of tissue flap were closed directly or treated with skin grafting.After operation,the blood supply and survival of the flap,the survival of the distal limb,and the survival of the skin graft at the flap donor site were observed.Computed tomography angiography(CTA)was performed to observe the patency of the proximal and distal anastomotic arteries from 2 to 4 weeks after surgery.During follow-up,the texture of the flap,the survival of the grafted skin and the healing of the donor area were observed.Results One patient(complete forearm disconnection)developed distal limb blood disorder on 5 days after surgery.CTA examination suggested embolization of the distal anastomosis of the flow-through artery.more muscle and skin and soft tissue necrosis of the distal limb showed in emergency exploration.So,amputation was performed ultimately.No vascular crisis occurred in the skin flaps of the remaining 10 patients,and all skin flaps,distal limbs and the skin grafts in flap donor sites survived well.Two to 4 weeks after surgery,the proximal and distal ends of the anastomosed arteries were good in the patency.Follow-up for 11-37 months,the flap texture was good,and all donor site wounds healed well.Conclusions The use of anterolateral thigh flow-through chimeric perforator flap to repair upper limb complex tissue defects accompanied by main artery injury can improve the success rate of limb salvage,which can be promoted in clinical practice.
作者
刘飞
闫炜琪
马强
刘亦斌
杨智斌
Liu Fei;Yan Weiqi;Ma Qiang;Liu Yibin;Yang Zhibin(Department of Hand,Foot and Ankle Surgery,General Hospital of Ningxia Medical University,Yinchuan 750001,China;Department of Burns,Plastic and Cosmetic Surgery,General Hospital of Ningxia Medical University,Yinchuan 750001,China;Department of Plastic and Cosmetic Surgery,the Second Affiliated Hospital of Army Medical University(the Third Military Medical University),Chongqing 400037,China)
出处
《中华烧伤与创面修复杂志》
CAS
CSCD
北大核心
2024年第2期172-179,共8页
Chinese Journal of Burns And Wounds
基金
宁夏回族自治区自然科学基金项目(2022AAC03610)
宁夏回族自治区重点研发计划项目(2020BEG03025)。
