文章简介

出版社:J Plast Surg Hand Surg

作   者:Mateev MA, Kuokkanen HO.

编   号:10.3109/2000656X.2011.634562

年   份:2012    点击量:532

文章摘要

    Since the introduction of perforator-based flaps, new flaps have been described for reconstruction of soft tissue defects in the extremities. Pedicled perforator flaps, often called propeller flaps, are based on a single perforator and are local axial flaps that can be rotated up to 180° with the single perforator as the pivotal point. Pedicle perforator flaps have gained popularity because they have a shorter operating time than free flaps. However, some concern has been raised about their reliability. Here we report our results of 11 soft tissue reconstructions in the lower leg and 14 in the upper extremity. The defects were mostly traumatic or caused by release of burn scars. The mean size of the flaps in the lower leg was 52 cm² (range 126–15 cm²). In the upper extremity it was 24 cm² (range 12–35 cm²). All patients were followed until the wound had healed. In the upper extremity there was only one partial necrosis of the flap, and one patient had an infected wound. One haematoma was evacuated postoperatively, and all the rest healed uneventfully. In the lower leg we had one total necrosis and one partial necrosis of the flap and one infected wound. A free scapular flap was used for salvage in one case, and revision and skin grafting in two. The pedicled perforator flap is reliable, particularly in the upper extremity. The operation is quick and can be done under regional anaesthesia. The flap is thin and has a local texture that gives a good functional and aesthetic result. The pedicled perforator flap is a little unpredictable in the lower leg, probably because the directions of the vessels that arise from the perforator are not consistent.

    自穿支皮瓣技术应用以来,新型皮瓣技术重建四肢软组织缺损已受到关注。蒂穿支皮瓣通常被称为螺旋桨皮瓣,其基于单一穿支,且是局部轴向皮瓣,可以单一穿支为轴旋转180°。蒂穿支皮瓣术较游离皮瓣术的手术时间更短,因此广受欢迎。然而,其可靠性却受到一些质疑。文中报道了11例小腿和14例上肢软组织重建的结果。损伤多是外伤或烧伤瘢痕引起的。小腿和上肢皮瓣平均大小分别为52 cm²(126-15 cm²不等)和24 cm²(12-35 cm²不等)。对所有患者进行随访,直至伤口愈合。上肢端,1例患者皮瓣局部坏死,1例伤口感染。1例血肿术后疏散,其余均完全恢复。小腿端,1例患者皮瓣完全坏死,1例局部坏死,1例伤口感染。1例患者采用游离肩胛皮瓣术,2例进行修复和皮肤移植术。蒂穿支皮瓣是一种可靠的手术方法,尤其针对上肢。手术时间短,可在局部麻醉下进行。皮瓣很薄且具有局部纹理,具有很好的功能和外观效果。蒂穿支皮瓣在小腿处的应用效果难以预测,可能是由于穿支处血管方向不一致。

 

 

由MediCool医库软件 余晓倩 编译

原文来自J Plast Surg Hand Surg