携带腓肠外侧皮神经的游离腓动脉穿支皮瓣修复在手足部软组织缺损中的应用
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摘要
目的:探讨携带腓肠外侧皮神经的游离腓动脉穿支皮瓣修复在手足部软组织缺损中的应用。方法:选取2016年6月-2017年5月本院收治的手足部软组织缺损患者15例为研究组,2015年6月-2016年5月本院收治的手足部软组织缺损患者15例为对照组。对照组分别接受腹部带蒂皮瓣、游离足背皮瓣、游离股前外侧皮瓣、腓肠神经营养血管逆行皮瓣、股前外侧皮瓣修复,研究组接受携带腓肠外侧皮神经的游离腓动脉穿支皮瓣修复治疗。比较两组患者对外观恢复的满意情况、皮瓣成活率及皮肤弹性、瘢痕评分、感觉功能恢复及并发症情况。结果:研究组皮瓣成活率高于对照组(P<0.05);研究组对外观恢复的总满意度为100%,高于对照组的66.7%(P<0.05);术后3、6个月,研究组瘢痕评分均低于对照组(P<0.05),但两组皮肤弹性评分比较差异无统计学意义(P>0.05);术后6、12个月,研究组的感觉正常患者例数均多于对照组(P<0.05);研究组术后并发症的发生率为13.3%,明显低于对照组的73.3%(P<0.05)。结论:携带腓肠外侧皮神经的游离腓动脉穿支皮瓣修复治疗手足部软组织缺损的效果理想,临床上应当进一步推广应用。
Objective:To explore the application of free peroneal artery perforator flaps with lateral sural cutaneous nerve in repairing soft tissue defects of hand and foot.Method:A total of 15 patients with soft tissue defect of hand and foot from June 2016 to May 2017 in our hospital were selected as study group,and 15 patients with soft tissue defect of hand and foot from June 2015 to May 2016 as control group.The control group was treated with abdominal pedicled skin flap,free dorsal foot skin flap,free anterolateral thigh skin flap,sural neurotrophic vessel retrograde skin flap and anterolateral thigh skin flap respectively,and study group received free peroneal artery perforator flaps with lateral sural cutaneous nerve.The satisfaction of appearance recovery,survival rate of skin flaps,skin elasticity,scar score,sensory function recovery and complications between two groups were compared.Result:The survival rate of flaps in study group was higher than that of control group(P<0.05).The total satisfaction rate of study group was 100%,which was higher than 66.7% of control group(P<0.05).After operation 3 and 6 months,the scar scores in study group were lower than those of control group(P<0.05),but the skin elasticity scores of two groups was compared,the difference was not statistically significant(P>0.05).After operation 6 and 12 months,the number of patients with normal sensation in study group were higher than those of control group(P<0.05).The incidence of postoperative complications was 13.3% in study group,which was significantly lower than 73.3% in control group(P<0.05).Conclusion:The free peroneal artery perforator flaps with lateral sural cutaneous nerve is an ideal treatment for soft tissue defect of hand and foot,it should be further popularized and applied in clinic.
Objective:To explore the application of free peroneal artery perforator flaps with lateral sural cutaneous nerve in repairing soft tissue defects of hand and foot.Method:A total of 15 patients with soft tissue defect of hand and foot from June 2016 to May 2017 in our hospital were selected as study group,and 15 patients with soft tissue defect of hand and foot from June 2015 to May 2016 as control group.The control group was treated with abdominal pedicled skin flap,free dorsal foot skin flap,free anterolateral thigh skin flap,sural neurotrophic vessel retrograde skin flap and anterolateral thigh skin flap respectively,and study group received free peroneal artery perforator flaps with lateral sural cutaneous nerve.The satisfaction of appearance recovery,survival rate of skin flaps,skin elasticity,scar score,sensory function recovery and complications between two groups were compared.Result:The survival rate of flaps in study group was higher than that of control group(P<0.05).The total satisfaction rate of study group was 100%,which was higher than 66.7% of control group(P<0.05).After operation 3 and 6 months,the scar scores in study group were lower than those of control group(P<0.05),but the skin elasticity scores of two groups was compared,the difference was not statistically significant(P>0.05).After operation 6 and 12 months,the number of patients with normal sensation in study group were higher than those of control group(P<0.05).The incidence of postoperative complications was 13.3% in study group,which was significantly lower than 73.3% in control group(P<0.05).Conclusion:The free peroneal artery perforator flaps with lateral sural cutaneous nerve is an ideal treatment for soft tissue defect of hand and foot,it should be further popularized and applied in clinic.
引文
[1]罗鹏,周斌,刘科,等.腓动脉穿支皮瓣联合腓肠神经营养血管皮瓣修复足背软组织缺损[J].中华显微外科杂志,2016,39(5):504-505.
[2]汤样华,曾林如,辛大伟,等.游离腓动脉穿支皮瓣修复老年患者前足软组织缺损[J].中华显微外科杂志,2016,39(4):344-347.
[3] Hwaiz R,Rahman M,Zhang E,et al.Platelet secretion of CXCL4 is Rac1-dependent and regulates neutrophil infiltration and tissue damage in septic lung damage[J].Br J Pharmacol,2015,172(22):5347-5359.
[4]吕荼,李子华,黄若强.腓动脉穿支接力皮瓣修复手足部创面的疗效[J].中国矫形外科杂志,2016,24(20):1859-1863.
[5]尹路,宫可同,殷中罡,等.游离穿支皮瓣联合游离植皮修复足踝部软组织缺损的疗效观察[J].中国修复重建外科杂志,2017,31(3):319-322.
[6]李忠义,于宁,李晓芳,等.微型游离腓动脉穿支皮瓣修复对手部小创面患者感染及其相关血液指标的影响研究[J].中华医院感染学杂志,2016,26(17):3981-3983.
[7] Shen L,Liu Y,Zhang C,et al.Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction:Clinical applications and treatment of venous congestion[J].J Int Med Res,2017,45(3):1074-1089.
[8]孙广峰,聂开瑜,祁建平,等.腓肠内侧动脉穿支皮瓣游离移植修复前足背侧创面的研究[J].中国修复重建外科杂志,2016,30(3):378-381.
[9]李学渊,王扬剑,章伟文,等.端侧吻合与端端吻合法在游离穿支皮瓣修复手部软组织缺损病例中的对比研究[J].中华显微外科杂志,2016,39(1):8-11.
[10] Weavers H,Liepe J,Sim A,et al.Systems Analysis of the Dynamic Inflammatory Response to Tissue Damage Reveals Spatiotemporal Properties of the Wound Attractant Gradient[J].Curr Biol,2016,26(15):1975-1989.
[11]付记乐,高峻青,张家盛,等.同期应用小腿内侧和外侧动脉穿支皮瓣修复足踝部复杂创面[J].中华显微外科杂志,2016,39(3):293-296.
[12]胡涛,袁智丽,王进,等.小腿穿支螺旋桨皮瓣在修复足踝部软组织缺损中的临床应用[J].中华显微外科杂志,2016,39(3):279-281.
[13]尹路,宫可同,殷中罡,等.穿支皮瓣游离移植修复手部软组织缺损[J].中华手外科杂志,2016,32(6):451-453.
[14] Tomk?tter L,Erbes J,Trepte C,et al.The Effects of Pancreatic Microcirculatory Disturbances on Histopathologic Tissue Damage and the Outcome in Severe Acute Pancreatitis[J].Pancreas,2016,45(2):248-253.
[15]王璋斌,董忠根,武文臣,等.儿童与成人腓动脉穿支筋膜蒂皮瓣修复小腿不同部位皮肤软组织缺损的疗效比较[J].中华创伤杂志,2016,32(9):823-828.
[16]霍星辰,刘会仁,高双全,等.腓动脉穿支腓肠神经营养血管皮瓣修复足踝部软组织缺损[J].中国临床解剖学杂志,2017,35(6):681-683.
[17]李涛,陈振兵,丛晓斌,等.保留腓肠神经的小腿后外侧穿支皮瓣的临床应用[J].中华手外科杂志,2016,32(2):127-129.
[18] Cordaro M,Paterniti I,Siracusa R,et al.KU0063794,a Dual mTORC1 and mTORC2 Inhibitor,Reduces Neural Tissue Damage and Locomotor Impairment After Spinal Cord Injury in Mice[J].Mol Neurobiol,2017,54(4):2415-2427.
[19]周洪翔,陈亮,李俊杰,等.改良螺旋桨穿支皮瓣在修复足跟周围软组织缺损中的应用[J].中国矫形外科杂志,2017,25(6):517-520.
[20]黎润超,熊秉刚,黎明华.拇指皮肤软组织缺损皮瓣修复方法的选择及临床体会[J].中国医学创新,2012,9(11):212-214.
[21]李文君,苏波,张玲玲,等.游离穿支皮瓣修复(拇)趾腓侧皮瓣和(拇)甲瓣术后供区[J].中华显微外科杂志,2016,39(2):180-182.
[2]汤样华,曾林如,辛大伟,等.游离腓动脉穿支皮瓣修复老年患者前足软组织缺损[J].中华显微外科杂志,2016,39(4):344-347.
[3] Hwaiz R,Rahman M,Zhang E,et al.Platelet secretion of CXCL4 is Rac1-dependent and regulates neutrophil infiltration and tissue damage in septic lung damage[J].Br J Pharmacol,2015,172(22):5347-5359.
[4]吕荼,李子华,黄若强.腓动脉穿支接力皮瓣修复手足部创面的疗效[J].中国矫形外科杂志,2016,24(20):1859-1863.
[5]尹路,宫可同,殷中罡,等.游离穿支皮瓣联合游离植皮修复足踝部软组织缺损的疗效观察[J].中国修复重建外科杂志,2017,31(3):319-322.
[6]李忠义,于宁,李晓芳,等.微型游离腓动脉穿支皮瓣修复对手部小创面患者感染及其相关血液指标的影响研究[J].中华医院感染学杂志,2016,26(17):3981-3983.
[7] Shen L,Liu Y,Zhang C,et al.Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction:Clinical applications and treatment of venous congestion[J].J Int Med Res,2017,45(3):1074-1089.
[8]孙广峰,聂开瑜,祁建平,等.腓肠内侧动脉穿支皮瓣游离移植修复前足背侧创面的研究[J].中国修复重建外科杂志,2016,30(3):378-381.
[9]李学渊,王扬剑,章伟文,等.端侧吻合与端端吻合法在游离穿支皮瓣修复手部软组织缺损病例中的对比研究[J].中华显微外科杂志,2016,39(1):8-11.
[10] Weavers H,Liepe J,Sim A,et al.Systems Analysis of the Dynamic Inflammatory Response to Tissue Damage Reveals Spatiotemporal Properties of the Wound Attractant Gradient[J].Curr Biol,2016,26(15):1975-1989.
[11]付记乐,高峻青,张家盛,等.同期应用小腿内侧和外侧动脉穿支皮瓣修复足踝部复杂创面[J].中华显微外科杂志,2016,39(3):293-296.
[12]胡涛,袁智丽,王进,等.小腿穿支螺旋桨皮瓣在修复足踝部软组织缺损中的临床应用[J].中华显微外科杂志,2016,39(3):279-281.
[13]尹路,宫可同,殷中罡,等.穿支皮瓣游离移植修复手部软组织缺损[J].中华手外科杂志,2016,32(6):451-453.
[14] Tomk?tter L,Erbes J,Trepte C,et al.The Effects of Pancreatic Microcirculatory Disturbances on Histopathologic Tissue Damage and the Outcome in Severe Acute Pancreatitis[J].Pancreas,2016,45(2):248-253.
[15]王璋斌,董忠根,武文臣,等.儿童与成人腓动脉穿支筋膜蒂皮瓣修复小腿不同部位皮肤软组织缺损的疗效比较[J].中华创伤杂志,2016,32(9):823-828.
[16]霍星辰,刘会仁,高双全,等.腓动脉穿支腓肠神经营养血管皮瓣修复足踝部软组织缺损[J].中国临床解剖学杂志,2017,35(6):681-683.
[17]李涛,陈振兵,丛晓斌,等.保留腓肠神经的小腿后外侧穿支皮瓣的临床应用[J].中华手外科杂志,2016,32(2):127-129.
[18] Cordaro M,Paterniti I,Siracusa R,et al.KU0063794,a Dual mTORC1 and mTORC2 Inhibitor,Reduces Neural Tissue Damage and Locomotor Impairment After Spinal Cord Injury in Mice[J].Mol Neurobiol,2017,54(4):2415-2427.
[19]周洪翔,陈亮,李俊杰,等.改良螺旋桨穿支皮瓣在修复足跟周围软组织缺损中的应用[J].中国矫形外科杂志,2017,25(6):517-520.
[20]黎润超,熊秉刚,黎明华.拇指皮肤软组织缺损皮瓣修复方法的选择及临床体会[J].中国医学创新,2012,9(11):212-214.
[21]李文君,苏波,张玲玲,等.游离穿支皮瓣修复(拇)趾腓侧皮瓣和(拇)甲瓣术后供区[J].中华显微外科杂志,2016,39(2):180-182.