股后内侧区游离股深动脉穿支皮瓣修复四肢创面
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摘要
目的探讨应用股后内侧区游离股深动脉穿支皮瓣(profunda artery perforator flap,PAPF)修复外伤性肢体皮肤缺损的疗效。方法 2015年3月—2017年4月,采用股后内侧区游离PAPF修复外伤性肢体皮肤缺损伴深部组织外露11例。男7例,女4例;年龄26～54岁,平均39岁。手、前臂皮肤缺损4例,小腿、足部皮肤缺损7例。致伤原因:交通事故伤6例,机器挤压伤3例,压砸伤2例。创面范围11 cm×7 cm～18 cm×11 cm。受伤入院至皮瓣修复时间4～9 d,平均7.3 d。术中游离PAPF切取范围为15 cm×9 cm～22 cm×13 cm;8例供区一期闭合,3例无法直接闭合采用植皮覆盖创面。结果术中皮瓣切取时间为40～90 min,平均47 min。术后所有皮瓣及植皮区均顺利成活,创面Ⅰ期愈合。11例患者均获随访,随访时间6～19个月,平均12个月。皮瓣质地柔软,颜色与伤肢周围皮肤相似,无明显色素沉着及毛发生成。其中3例患者进行了二期皮瓣修薄。末次随访时所有患者伤肢功能恢复良好。皮瓣供区可见纵形瘢痕,位置隐蔽;所有患者随访过程中均未诉皮瓣供区瘢痕影响性生活。结论股后内侧区游离PAPF具有穿支恒定、术式简便、供区隐蔽的优点,修复四肢皮肤缺损创面能取得满意疗效。
Objective To explore the effectiveness of free profounda artery perforator flap(PAPF) in the posteromedial femoral region for the treatment of traumatic skin defects of limbs. Methods Between March 2015 and April 2017, 11 cases of traumatic limb skin defect with deep tissue exposure were treated with free PAPF in posteromedial femoral region. There were 7 males and 4 females, with an average age of 39 years(range, 26-54 years). There were 4 cases of upper limb skin defect and 7 cases of lower limb skin defect. The causes of injury included 6 cases of traffic accident injury, 3 cases of machine crush injury, and 2 cases of crush injury. The size of wounds ranged from 11 cm×7 cm to18 cm×11 cm. The time from post-traumatic admission to flap repair were 4-9 days(mean, 7.3 days). The size of free PAPF ranged from 15 cm×9 cm to 22 cm×13 cm. The donor site of 8 cases were closed directly; 3 cases could not be closed directly, and skin grafting was used to cover the wound. Results The time of skin flap harvest was 40-90 minutes(mean,47 minutes). All flaps and skin grafts survived and the wounds healed by first intention. All the 11 patients were followed up 6-19 months(mean, 12 months). The skin flaps were soft in texture, similar in color to the skin around the injured limbs, without obvious pigmentation and hair overgrowth. Three of them underwent second-stage skin flap thinning. At last follow-up, the limb function of all patients recovered well. Longitudinal scar could be seen in the donor site of the flap,and the location was concealed. All patients did not complain that scar of the donor site affected their sexual life during the follow-up. Conclusion Free PAPF can achieve satisfactory results in repairing skin defects of extremities. The flaps have the advantages including constant perforator branches, simple operation, and concealed donor site.
Objective To explore the effectiveness of free profounda artery perforator flap(PAPF) in the posteromedial femoral region for the treatment of traumatic skin defects of limbs. Methods Between March 2015 and April 2017, 11 cases of traumatic limb skin defect with deep tissue exposure were treated with free PAPF in posteromedial femoral region. There were 7 males and 4 females, with an average age of 39 years(range, 26-54 years). There were 4 cases of upper limb skin defect and 7 cases of lower limb skin defect. The causes of injury included 6 cases of traffic accident injury, 3 cases of machine crush injury, and 2 cases of crush injury. The size of wounds ranged from 11 cm×7 cm to18 cm×11 cm. The time from post-traumatic admission to flap repair were 4-9 days(mean, 7.3 days). The size of free PAPF ranged from 15 cm×9 cm to 22 cm×13 cm. The donor site of 8 cases were closed directly; 3 cases could not be closed directly, and skin grafting was used to cover the wound. Results The time of skin flap harvest was 40-90 minutes(mean,47 minutes). All flaps and skin grafts survived and the wounds healed by first intention. All the 11 patients were followed up 6-19 months(mean, 12 months). The skin flaps were soft in texture, similar in color to the skin around the injured limbs, without obvious pigmentation and hair overgrowth. Three of them underwent second-stage skin flap thinning. At last follow-up, the limb function of all patients recovered well. Longitudinal scar could be seen in the donor site of the flap,and the location was concealed. All patients did not complain that scar of the donor site affected their sexual life during the follow-up. Conclusion Free PAPF can achieve satisfactory results in repairing skin defects of extremities. The flaps have the advantages including constant perforator branches, simple operation, and concealed donor site.
引文
1 Allen RJ, Haddock NT, Ahn CY, et al. Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg, 2012,129(1):16e-23e.
2宋达疆,李赞,周晓,等.不同形式游离股深动脉蒂嵌合穿支肌皮瓣修复舌癌术后缺损的疗效观察.中国修复重建外科杂志,2017, 31(6):696-701.
3 Teotia SS, Cho MJ, Haddock NT. Salvaging breast reconstruction:profunda artery perforator flaps using thoracodorsal vessels. Plast Reconstr Surg Glob Open, 2018,6(9):e1837.
4卿黎明,贺继强,唐举玉,等.基于活体造影数据的股深动脉穿动脉穿支血管的数字解剖学研究.中国临床解剖学杂志,2016,34(1):12-15.
5 DeLong MR, Hughes DB, Bond JE, et al A detailed evaluation of the anatomical variations of the profunda artery perforator fap using computed tomographic angiograms. Plast Reconstr Surg,2014:134(2):186e-192e.
6 Angrigiani C, Grilli D, Thorne CH. The adductor flap:a new method for transferring posterior and medial thigh skin. Plast Reconstr Surgi 2001,107(7):1725-1731.
7贺继强.股深动脉穿动脉穿支皮瓣的解剖及临床应用进展.中国临床解剖学杂志,2017, 35(4):475-477.
8刘温悦,穆兰酝,张寒,等.股深动脉穿支皮瓣应用于乳房再造的解剖学研究.中国临床解剖学杂志,2014t 32(4):384-386.
9 Mohan AT, Zhu L, Sur YJ, et al. Application of posterior thigh three-dimensional profunda artery perforator perforasomes in refining next-generation flap designs:transverse, vertical, and Sshaped profunda artery perforator flaps. Plast Reconstr Surg, 2017,139(4):834e-845e.
10 Wu JC, Huang JJ, Tsao CK, et al. Comparison of posteromedial thigh profunda artery perforator flap and anterolateral thigh perforator flap for head and neck reconstruction. Plast Reconstr Surg,2016, 137(1):257-266.
11王剑利,王根,赵刚,等.游离股后侧穿支动脉皮瓣的解剖学研究及临床应用.中华显微外科杂志,2013, 36(1):7-10.
12穆籣,彭喆,毕晔,等.双侧游离股深动脉穿支皮瓣即刻乳房再造一例报告并文献复习.中华显微外科杂志,2016, 39(6):555-558.
13 Saad A, Sadeghi A, Allen RJ. The anatomic basis of the profunda femoris artery perforator flap:a new option for autologous breast reconstruction—a cadaveric and computer tomography angiogram study. J Reconstr Microsurg, 2012, 28(6):381-386.
14 Hunsinger V, Lhuaire M, Haddad K, et al. Medium-and largesized autologous breast reconstruction using a fleur-de-lys profunda femoris artery perforator flap design:a report comparing results with the horizontal profunda femoris artery perforator flap.J Reconstr Microsurg, 2019, 35(1):8-14.
15 Haddock NT, Greaney P, Otterburn D, et al. Predicting perforator location on preoperative imaging for the profunda artery perforator flap. Microsurgery, 2012, 32(7):507-511.
16宋达疆,李赞,周晓,等.股前内侧接力穿支皮瓣修复游离股前外侧穿支皮瓣供区的临床应用.中国修复重建外科杂志,2017,31(1):52-56.
17 Rozen WM, Donahoe S, Wilson JL. The profunda femoris artery"fourth perforator"island flap:a new perforator flap in lower-limb reconstruction. J Reconstr Microsurg, 2011, 27(4):273-276.
18 Ahmadzadeh R, Bergeron L, Tang M, et al. The posterior thigh perforator flap or profunda femoris artery perforator flap. Plast Reconstr Surg, 2007,119(1):194-202.
2宋达疆,李赞,周晓,等.不同形式游离股深动脉蒂嵌合穿支肌皮瓣修复舌癌术后缺损的疗效观察.中国修复重建外科杂志,2017, 31(6):696-701.
3 Teotia SS, Cho MJ, Haddock NT. Salvaging breast reconstruction:profunda artery perforator flaps using thoracodorsal vessels. Plast Reconstr Surg Glob Open, 2018,6(9):e1837.
4卿黎明,贺继强,唐举玉,等.基于活体造影数据的股深动脉穿动脉穿支血管的数字解剖学研究.中国临床解剖学杂志,2016,34(1):12-15.
5 DeLong MR, Hughes DB, Bond JE, et al A detailed evaluation of the anatomical variations of the profunda artery perforator fap using computed tomographic angiograms. Plast Reconstr Surg,2014:134(2):186e-192e.
6 Angrigiani C, Grilli D, Thorne CH. The adductor flap:a new method for transferring posterior and medial thigh skin. Plast Reconstr Surgi 2001,107(7):1725-1731.
7贺继强.股深动脉穿动脉穿支皮瓣的解剖及临床应用进展.中国临床解剖学杂志,2017, 35(4):475-477.
8刘温悦,穆兰酝,张寒,等.股深动脉穿支皮瓣应用于乳房再造的解剖学研究.中国临床解剖学杂志,2014t 32(4):384-386.
9 Mohan AT, Zhu L, Sur YJ, et al. Application of posterior thigh three-dimensional profunda artery perforator perforasomes in refining next-generation flap designs:transverse, vertical, and Sshaped profunda artery perforator flaps. Plast Reconstr Surg, 2017,139(4):834e-845e.
10 Wu JC, Huang JJ, Tsao CK, et al. Comparison of posteromedial thigh profunda artery perforator flap and anterolateral thigh perforator flap for head and neck reconstruction. Plast Reconstr Surg,2016, 137(1):257-266.
11王剑利,王根,赵刚,等.游离股后侧穿支动脉皮瓣的解剖学研究及临床应用.中华显微外科杂志,2013, 36(1):7-10.
12穆籣,彭喆,毕晔,等.双侧游离股深动脉穿支皮瓣即刻乳房再造一例报告并文献复习.中华显微外科杂志,2016, 39(6):555-558.
13 Saad A, Sadeghi A, Allen RJ. The anatomic basis of the profunda femoris artery perforator flap:a new option for autologous breast reconstruction—a cadaveric and computer tomography angiogram study. J Reconstr Microsurg, 2012, 28(6):381-386.
14 Hunsinger V, Lhuaire M, Haddad K, et al. Medium-and largesized autologous breast reconstruction using a fleur-de-lys profunda femoris artery perforator flap design:a report comparing results with the horizontal profunda femoris artery perforator flap.J Reconstr Microsurg, 2019, 35(1):8-14.
15 Haddock NT, Greaney P, Otterburn D, et al. Predicting perforator location on preoperative imaging for the profunda artery perforator flap. Microsurgery, 2012, 32(7):507-511.
16宋达疆,李赞,周晓,等.股前内侧接力穿支皮瓣修复游离股前外侧穿支皮瓣供区的临床应用.中国修复重建外科杂志,2017,31(1):52-56.
17 Rozen WM, Donahoe S, Wilson JL. The profunda femoris artery"fourth perforator"island flap:a new perforator flap in lower-limb reconstruction. J Reconstr Microsurg, 2011, 27(4):273-276.
18 Ahmadzadeh R, Bergeron L, Tang M, et al. The posterior thigh perforator flap or profunda femoris artery perforator flap. Plast Reconstr Surg, 2007,119(1):194-202.