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    • 基于旋髂浅动脉设计的联体皮瓣修复下肢大面积软组织缺损

    唐林,周鑫,黄宇,黄波,刘安铭,陈孝均,邹永根

    Chinese Journal of Microsurgery（2022）

    Cited 0|Views17
    Abstract
    目的:探讨基于旋髂浅动脉(SCIA)设计的联体皮瓣修复下肢大面积软组织缺损的临床疗效。方法:回顾分析2017年2月-2019年6月收治的脱套伤致下肢大面积软组织缺损患者15例,缺损范围为25.0 cm×8.0 cm~50.0 cm×15.0 cm。急诊予以彻底清创及创面VSD处理,待创面肉芽组织生长红润后,以下腹壁及侧胸壁为供区,根据创面特征设计形状及大小匹配的联体皮瓣;穿支组合包括双侧SCIA、SCIA加胸背动脉(TA)降支;供区直接一期闭合;由同一组医生门诊随访评估术后效果。结果:术后除1例纵向皮瓣边缘部分坏死,经二期植皮后愈合,其余皮瓣全部成活,供、受区创面均Ⅰ期愈合。随访时间16~24个月,平均18个月;皮瓣外形满意,质地柔软,末次随访时未出现异常毛发生长、色素沉着等;供区仅遗留线形瘢痕,未出现腹壁疝等并发症,肩、髋、膝活动未受影响;小腿及足踝功能重建满意,按下肢功能评定标准( LEFS)评分,优7例、良1例,按美国矫形足踝协会(AOFAS)评分标准评定,结果优6例、良1例。结论:基于SCIA制备的联体皮瓣,供区隐蔽,设计灵活,切取面积大,能修复肢体大面积软组织缺损,以最大程度实现保肢治疗。
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    Key words
    Superficial circumflex iliac artery,Thoracodorsal artery,Conjoined flap,Lower extremity,Repair
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    【要点】：研究应用基于浅 circumflex iliac 动脉（SCIA）的联合皮瓣修复极大下肢缺损的效果，此方法提供了同时重建巨大下肢缺损和更好的挽救治疗的可能性。
    

    【方法】：通过采用腹壁或侧胸壁作为供区，在伤口表面肉芽生长后进行联合皮瓣的剥离，并利用双侧SCIA或同侧SCIA和胸背动脉（TA）的穿支匹配方式。
    

    【实验】：2017年2月至2019年6月间，15名患者（包括9名男性和6名女性，平均年龄45岁）因严重下肢剥脱伤入院，急诊手术中彻底清创后使用VSD装置覆盖，缺损尺寸介于25.0 cm × 8.0 cm至50.0 cm × 15.0 cm。所有供区均一期闭合，随访由同一位外科医师完成。14个皮瓣完全存活，1个皮瓣远端坏死，二期植皮治愈。平均随访18个月，美学效果良好，供区隐蔽，功能受限小。根据LEFS和AOFAS标准评估，疗效优良。