应用带蒂皮瓣修复皮肤软组织缺损

摘要

目的 探讨带蒂皮瓣修复皮肤软组织缺损的效果.方法 回顾性分析2004年1月至2010年9月,因创伤造成皮肤软组织缺损的具有完整随访资料的87例患者的病例,男61例,女26例；年龄14～61岁,平均40岁.患者均采用不吻合血管的带蒂皮瓣进行修复.致伤原因:车祸伤23例,高压电损伤46例,碾压撕脱伤18例.缺损部位:手部21例,下肢66例.皮瓣种类:邻近转位皮瓣50例,远位转移皮瓣37例.皮瓣面积:2.0 cm×1.5 cm～18 cm×12 cm.供区部位:小腿61例,腹部18例,手部8例.术前25例患者合并骨髓炎,其中骨和(或)钢板外露23例,高压电损伤2例.钢板外露患者皮瓣移植前均取出内置物.结果 术后3例患者出现皮瓣下血肿,经手术清除,未对皮瓣成活造成影响.1例术后因肢体固定位置移动造成蒂部受压,导致皮瓣远端宽约2 cm组织发生血运障碍,经6周换药皮瓣成活.37例远位转移皮瓣于术后3周行二期断蒂手术.27例皮瓣一期愈合；47例二期愈合；13例皮瓣移植前取出钢板的患者术后发生感染,皮瓣不愈合,9例在1年内经清除坏死病灶,皮瓣愈合,另4例目前仍未愈合.87例患者均获得随访,随访时间3～60个月,平均13个月,患者满意率为90.80％ (79/87).结论 带蒂皮瓣较少受手术设计的限制,术中操作简单,皮瓣成活率高,可以较好地应用于皮肤软组织缺损的修复.%Objective To explore the effect of using pedicle skin flaps for treatment of skin and soft tissue defects.Methods From January 2004 to September 2010,87 patients with skin and soft tissue injury which had been treated by using pedicle skin flaps without vessel anastomosis were retrospectively analyzed,including 61 males and 26 females with an average age of 40 years (range,14-61).The pedicle skin flaps selected were known vessel skin flaps or unknown vessel random skin flaps.The reconstruction treatment increased multiple selections of skin flaps for patients.Skin and soft tissue defects were located at the hand in 21 cases,at the lower extremities in 66.The kinds of skin flaps included adjacent transposition flaps in 50 cases,distal skin flaps in 37.The areas of the skin flaps were 2.0 cm×1.5 cm-18 cm×12 cm.Donor sites were as follows:lower leg in 61 cases,abdomen in 18,and hand in 8.Results Three patients appeared skin flaps hematoma after operation,which were removed immediately with no effect on flaps survival.Pedicle skin flap was compressed due to unstable fixation in 1 case,which made distal flap tissue necrosis approximately 2 cm in width.After dressing change for 6 weeks,the flaps got survival.Thirty seven patients underwent the second stage operation for breaking the perdicle 3 weeks after the first operation.All 87 patients were obtained follow-up for an average of 13 months (range,3-60).The total of 90.80％ patients treated with pedicle skin flaps were satisfied with the results.Conclusion Pedicle skin flap surgery can be performed more easily with less limitations of surgical designs.The survival rate of the flap is high,and the treatment of pedicle skin flaps could be well applied for soft tissue defects.