腹腔镜下切取大网膜游离移植修复肢体复杂创面
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摘要
目的评估腹腔镜切取自体大网膜游离移植的方法修复四肢复杂创面的有效性。方法 11例患者(机械损伤、软组织感染坏死7例,大面积深度烧伤4例)出现大面积、不规则软组织缺损创面,深部组织、骨、关节外露。先清创予以封闭式负压引流控制创面感染,创基较为清洁后行游离大网膜加自体薄中厚皮片移植覆盖创面。结果 11例移植的大网膜均成活良好,1例一期植皮小部分坏死,后经二期植皮封闭创面。术后3-12月随访,外观及功能良好。结论当出现肢体、躯干大面积缺损、感染的四肢复杂创面无法以常规的皮瓣移植修复时,可选用腹腔镜下切取自体大网膜、皮片游离移植的方法进行修复。
Objective To evaluate the effectiveness of repair of complex limbs wounds with free transplantation of greater omentum under laparoscopy in repair of complex extremity wounds. Methods Totally 11 cases(7 cases of large area deep wound and soft tissue infection and necrosis,4 cases of large area burns)were collected. They suffered from large and irregular tissue defects,along with exposure of deep tissue,bone and joint. They were performed complete debridement and enclosed negative pressure drainage for controlling the infection and then free transplantation of greater omentum and autologous thin split thickness free skin graft to cover the wound.Results All transplanted greater omentum survived in 11 patients,and the partial skin necrosis occurred in 1 patient and treated with the second skin graft. The appearance and function were favorable after 3- 12-month follow up. Conclusion The complex limbs wound with large area of defect,infection and bone exposure,can be repaired with free transplantation of autologous greater omentum and skin after failed by the routine method.
Objective To evaluate the effectiveness of repair of complex limbs wounds with free transplantation of greater omentum under laparoscopy in repair of complex extremity wounds. Methods Totally 11 cases(7 cases of large area deep wound and soft tissue infection and necrosis,4 cases of large area burns)were collected. They suffered from large and irregular tissue defects,along with exposure of deep tissue,bone and joint. They were performed complete debridement and enclosed negative pressure drainage for controlling the infection and then free transplantation of greater omentum and autologous thin split thickness free skin graft to cover the wound.Results All transplanted greater omentum survived in 11 patients,and the partial skin necrosis occurred in 1 patient and treated with the second skin graft. The appearance and function were favorable after 3- 12-month follow up. Conclusion The complex limbs wound with large area of defect,infection and bone exposure,can be repaired with free transplantation of autologous greater omentum and skin after failed by the routine method.
引文
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[2]Iglesias M,Butron P,Leon-Lopez DA,et al.Soft tissue reconstruction with omental free flap in complex upper extremity injuries:report of 13 cases[J].Microsurgery,2014,34(6):425-433.
[3]Mixter RC,Rao VK,Katsaros J,et al.Simultaneous reconstruction of cervical soft tissue and esophagus with a gastro-omental free flap[J].Plast Reconstr Surg,1990,86(5):905-909.
[4]Irons GB,Witzke DJ,Arnold PG,et al.Use of the omental free flap for soft-tissue reconstruction[J].Ann Plast Surg,1983,11(6):501-507.
[5]Zaha H.Oncoplastic volume replacement technique for the upper inner quadrant using the omental flap[J].Gland Surg,2015,4(3):263-269.
[6]Mclean DH,Buncke HJ.Autotransplant of omentum to a large scalp defect,with microsurgical revascularization[J].Plast Reconstr Surg,1972,49(3):268-274.
[7]Patel RS,Gilbert RW.Utility of the gastro-omental free flap in head and neck reconstruction[J].Curr Opin Otolaryngol Head Neck Surg,2009,17(4):258-262.
[8]van Wingerden JJ,Coret ME,van Nieuwenhoven CA,et al.The laparoscopically harvested omental flap for deep sternal wound infection[J].Eur J Cardiothorac Surg,2010,37(1):87-92.
[9]Salacinski HJ,Punshon G,Krijgsman B,et al.A hybrid compliant vascular graft seeded with microvascular endothelial cells extracted from human omentum[J].Artif Organs,2001,25(12):974-982.
[10]Kamei Y,Nakayama B,Toriyama K,et al.Combined fibular osteocutaneous and omental flaps[J].Plast Reconstr Surg,2007,119(5):1499-1504.
[11]Nguyen AT,Suami H.Laparoscopic Free Omental Lymphatic Flap for the Treatment of Lymphedema[J].Plast Reconstr Surg,2015,136(1):114-118.
[12]Tian Y,Ma H,Peng Y,et al.Preventive effect of omental flap in pancreaticoduodenectomy against postoperative complications:a meta-analysis[J].Hepatogastroenterology,2015,62(137):187-189.
[13]Crnjac A,Pivec V,Ivanecz A.Thoracobiliary fistulas:literature review and a case report of fistula closure with omentum majus[J].Radiol Oncol,2013,47(1):77-85.
[14]Tao SX,Tian GQ,Ge MH,et al.Primary extraskeletal osteosarcoma of omentum majus[J].World J Surg Oncol,2011,9:25.