髂腰真皮下血管网轴型皮瓣在手部创面修复中的应用(1)
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[摘要]目的：研究一种用于上肢远端皮肤软组织缺损的理想修复方法。方法：选择27例上肢远端(前臂及手部)皮肤软组织缺损创面进行修复研究。在同侧髂腰部设计所需大小和形状的髂腰轴型皮瓣，将该皮瓣进行精细减薄制成真皮下血管网轴型皮瓣，皮瓣中的旋髂浅动脉完好保留，带蒂转移修复上肢远端创面，3周后断蒂完成修复。结果：本组27个髂腰真皮下血管网轴型皮瓣移植后全部成活。12个月后随访18例，皮瓣组织无肿胀，表面美学效果满意，皮瓣感觉恢复较好。结论：髂腰轴型真皮下血管网带蒂皮瓣移植是修复上肢远端皮肤软组织缺损的理想方法。
[关键词]真皮下血管网轴型皮瓣；创面；移植
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2012)04-0536-02
Iliolumbar axial subdermal vascular network pedicle skin flap for repairing distal limb wounds
LI Jiang,GUO Xiao-ping,WANG Ke-hua,ZHAO Dong-hong,HAN Tong
(Department of Plastic Surgery,General Hospital of Jinan Military Region,Jinan 250031,Shandong,China)
Abstract: Objective To develop a simple and effective surgical technique for repairing skin and soft tissue defects on the distal arms. Methods 27 cases of patients with skin and soft tissue defects on the distal arms were chosen for this study. Iliolumbar axial pedicle skin flaps were designed on the same sides of iliolumbar areas, which were elevated and made into iliolumbar axial subdermal vascular network pedicle skin flap under precise thinning processes. The superficial circumflex iliac artery in the iliolumbar axial pedicle skin flaps were observed and well maintained. The precise thinned flaps were used to cover the wounds on the distal arms. Flap pedicles were cut at three weeks postoperatively. Results 27 iliolumbar axial subdermal vascular network skin flaps were all survived after transplantation. 14 patients were followed up 12 months postoperation without flap swelling phenomenon. Superficial aesthetics and skin sense were well restored. Conclusion Iliolumbar axial subdermal vascular network skin flap transplantation is an ideal technique for repairing distal limb wounds.
Key words:axial subdermal vascular network skin flap;wound;transplantation
皮瓣移植是修复和重建外科的常规技术，是覆盖骨骼、肌腱和神经等重要解剖结构外露的首选外科方法[1]。在整形外科，用皮瓣移植技术对外露部位皮肤软组织缺损进行功能和美观双重修复成为最高治疗目标。所以，设计和制作具有良好血运、感觉恢复快、美学效果好的皮瓣成为极其重要的临床问题。自2000年起，笔者选择了髂腰皮瓣进行研究，首先在一具尸体标本上制作出髂腰真皮下血管网轴型皮瓣，然后在急诊手术中复制出27个相同皮瓣，用于修复上肢远端的皮肤软组织缺损，取得优良治疗效果。
1 材料和方法
1.1 临床资料：本组27例前臂及手部皮肤软组织缺损，年龄15～53岁,平均32岁。外伤后创面16例，瘢痕切除后创面11例。全部采用髂腰真皮下血管网轴型皮瓣修复。
1.2 髂腰真皮下血管网轴型皮瓣的设计要点：以同侧腹股沟及其延长线为皮瓣中轴线，蒂部中点为髂前上棘。根据创面大小和形状设计皮瓣形态。皮瓣面积稍大小创面。
1.3 髂腰超薄轴型皮瓣的制作：按皮瓣设计线切开皮肤及皮下浅层脂肪，在深层脂肪和浅层脂肪界面掀起皮瓣，用手术剪将皮瓣脂肪层大部清除，粗略保留5mm厚的脂肪层。然后，在眼镜式2.5倍手术放大镜下用精细手术镊和精细手术剪将剩余脂肪组织作进一步减薄，仔细摘除脂肪小叶，保留小叶间结蒂组织，皮瓣上最终保留的脂肪组织平均厚度约2mm。操作中不损伤真皮下走行的皮肤直接营养血管 ......
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