摘要
目的 探讨功能性穿支皮瓣在四肢复合创面修复中重建感觉的临床效果。方法 回顾分析2018年3月—2023年1月收治的21例四肢复合创面患者临床资料。男12例,女9例;年龄19~62岁,中位年龄36岁。创面部位:上肢(手)13例、下肢(足)8例。其中5例为肿瘤病灶及瘢痕术中en-block切除后遗留创面,切除后即刻修复;其余16例为急/慢性创面,入院后急诊清创及安置封闭式负压引流敷料临时覆盖创面,二期皮瓣修复。创面范围5.5 cm×4.5 cm~17.0 cm×12.0 cm。皮瓣供区:胸背部4例,股前外侧6例,足部11例。皮瓣类型均为携带感觉神经的功能性穿支皮瓣。供区直接拉拢缝合或植皮修复。末次随访时,根据英国医学研究会(BMRC)感觉分级(S_(0)~S_(4))和肌力分级(M_(0)~M_(5))评定标准评价皮瓣感觉及受区功能恢复情况。结果 术后除1例皮瓣边缘部分坏死,经二期清创植皮后愈合;其余皮瓣全部成活,供、受区创面均Ⅰ期愈合。患者均获随访,随访时间10~18个月,平均12个月。末次随访时,皮瓣外形满意、质地柔软,未出现异常毛发生长、色素沉着等,皮瓣感觉恢复达S_(1) 2例、S_(2) 7例、S_(3) 9例、S_(4) 3例;受区肌力达M_(2) 4例、M_(3) 9例、M_(4) 5例、M_(5) 3例。供区仅遗留线性瘢痕。结论 携带感觉神经的功能性穿支皮瓣修复四肢复合创面,有利于早期感觉重建,能一期立体重建功能亚单位结构缺损,近期随访功能恢复满意。
Objective To investigate the clinical outcome of sensory reconstruction about the functional perforator flap for repairing the complex defects on the limbs.MethodsA retrospective analysis was conducted on 21 patients with limb complex defects admitted between March 2018 and January 2023.There were 12 males and 9 females,with a median age of 36 years(range,19-62 years).The wounds were on the upper limbs(hands)in 13 cases and the lower limbs(feet)in 8 cases.Five patients with tumor/scar,and the left defects after en-bloc resection of the tumor lesion and scar were repaired immediately.The remaining 16 cases were acute/chronic wounds,undergoing the emergent debridement and vacuum sealing drainage placement,and the left defects were repaired with flaps during second-stage operation.The size of the defects ranged from 5.5 cmx4.5 cm to 17.0 cmx12.0 cm.The donor sites were located on the thoracic and back in 4 cases,the anterior lateral thigh in 6 cases,and the feet in ll cases.All flaps were functional perforatorflaps with sensory nerve.The donor sites were closed directly or repaired with skin grafting.At last follow-up,the sensation of flap and the muscle strength of recipient site were evaluated according to the British Medical Research Council(BMRC)sensory grading(S-S.)and muscle strength grading(M_(0)-M_(5))criteria.ResultsTwenty flaps survived completely without significant complication,and partial edge necrosis was observed in 1 flap,which healed after the debridement and skin grafting.The donor and recipient sites healed by first intention.All patients were followed up 10-18 months(mean,12 months).At last follow-up,the flaps with satisfactory shape and soft texture were observed,and no abnormal hair growth or pigmentation occurred.The sensation offlap was evaluated as S in 2 cases,Sz in 7,S:in 9,and S.in 3.The muscle strength of recipient site was evaluated as M,in 4 cases,M,in 9,M,in 5,and M,in 3.Only linear scars wereleft at thedonor site.Conclusion The functional perforator flap with sensory nerve is beneficial for early sensation reconstruction for repairing the complex defects on the limbs,and could reconstruct the functional subunit structure defect in one stage.The short-term functional follow-up results are satisfactory.
作者
唐林
黄书清
张家平
周鑫
TANG Lin;HUANG Shuqing;ZHANG Jiaping;ZHOU Xin(Department of Orthopedics,Jiangbei Campus,the First Afiliated Hospital of Army Medical University of Chinese PLA,Chongqing,400020,P.R.China;Department of Plastic and Cosmetic Surgery,the Second Hospital of Army Medical University of Chinese PLA,Chongqing,400037,P.R.China;Department of Plastic and Cosmetic Surgery,the First Affiliated Hospital of Army Medical University of Chinses PLA,Chongqing,400038,P.R.China)
出处
《中国修复重建外科杂志》
北大核心
2025年第9期1091-1097,共7页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
功能性穿支皮瓣
感觉重建
功能修复
复合缺损
四肢
Functional perforator flap
sensation reconstruction
functional repair
complex defects
limb
