摘要：
目的 探讨会阴部亚单位缺损的修复重建方案.方法 对2008年1月至2018年12月解放军总医院第四医学中心烧伤整形五病区收治的21例会阴部缺损患者的临床资料进行回顾性分析.其中男10例,女11例,年龄4～68岁,平均26.4岁.受伤原因包括烧伤11例,外伤2例,Paget病2例,Brown病2例,会阴部鳞癌3例,血管瘤1例.根据会阴部解剖结构,分为4个亚单位:1个前区(阴阜或耻骨联合)、2个中区(阴唇或阴囊)和1个后区(肛周).会阴部病变切除后遗留创面23 cm×11 cm～5 cm×3 cm,根据会阴分区和组织缺损的情况选择合适的皮瓣进行修复.结果 21例患者中采用腹壁浅动脉岛状皮瓣修复9例,旋髂浅动脉皮瓣修复3例,腹壁浅动脉岛状皮瓣和旋髂浅动脉岛状皮瓣联合修复2例,阴部内动脉穿支皮瓣修复5例,股前外侧穿支皮瓣修复2例,皮瓣切取范围25 cm×12cm～6cm×3 cm,术后皮瓣全部成活,切口一期愈合.术后随访6个月至9年,平均13个月,供、受区外观良好,瘢痕隐蔽,患者满意.结论 根据会阴部亚单位分区原则合理选择皮瓣对会阴部缺损进行修复重建,可更好地恢复其功能和外观,取得满意的临床效果.%Objective To explore the subunit strategy for perineal defect reconstruction and flap selection.Methods This is a respective study of 21 patients,with perineal defect,during January 2008 to December 2018.All patients were admitted to the fifth section of Burn and Plastic Surgery in the Fourth Medical Center of the People's Liberation Army General Hospital.There were 10 males and 11 females,aged from 4 to 68 years old,with the mean age of 26.4 years.The causes of injury included burn (n =11),trauma (n=2),Paget's disease (n =2),Brown's disease (n =2),perineal squamous cell carcinoma (n=3)and hemangioma (n =1).The perineum is divided into 4 subunits,according to the anatomical structure:a front area monsveneris or pubic symphysis,2 middle areas (labia or scrotum) and a posterior area (anal).The defects ranged 23 cm × 11 cm-5 cm × 3 cm after perineal lesions were removed.Appropriate flaps were selected based on tissue defect.Results Nine patients were repaired with superficial inferior epigastric artery flap,3 patients were repaired with superficial circumflex iliac artery flap,and 2 patients were repaired with combined superficial inferior epigastric artery flap and superficial circumflex iliac artery island flap.Internal pudendal arterial perforator flap was performed in 5 patients,and anterolateral thigh perforator flap in 2 patients.The size of flap was 25 cm× 12 cm-6 cm×3 cm.All flaps survived,and incisions were primary healing.Patients were followed up for 6 months to 9 years,with an average of 13 months.The patients were satisfied with the appearances and functions of the recipient and doner sites.Scars were concealed well.Conclusions Appropriate flap can be chosen to repair perineal defects,based on the subunit principle in perineum,in order to restore function and appearance,and achieve satisfactory clinical outcomes.
