非岛状远端蒂腓肠动脉皮瓣：一种解决不可靠皮瓣问题的可靠方法。

Non-Islanded Distally Based Sural Artery Flap : A Reliable Solution for an Unreliable Flap.

作者信息

Raza Muhammad Sheraz, Nazir Umer, Ansari Hamid Hussain, Khan Farid Ahmad

机构信息

Department of Plastic Surgery and Burn Unit, Mayo Hospital, KEMU, Lahore.

出版信息

J Coll Physicians Surg Pak. 2016 Apr;26(4):310-4.

PMID:27097704

Abstract

OBJECTIVE

To assess the reliability of non-islanded distally based sural artery flap, in terms of number of flap failure (partial and major flap necrosis), number of surgeries related to the problem for which flap surgery was performed, hospital stay and return to work, for coverage of soft tissue defects of the distal one-third of leg, ankle and heel.

STUDY DESIGN

Cohort study.

PLACE AND DURATION OF STUDY

Department of Plastic Surgery and Burn Unit, Mayo Hospital, KEMU, Lahore, Pakistan, from January 2003 to March 2014.

METHODOLOGY

Distally based sural artery flaps in 87 patients requiring coverage of distal lower lumb were studied, retrospectively. They were divided into two groups. G1 included 46 cases in which distally based sural artery flap was islanded. G2 included 41 cases in which flap was not islanded and pedicle was raised. The variables that were measured in two groups included age, gender, size and cause of defect, co-morbidities, number of surgeries, total hospital stay, return to work and flap related complications. Independent sample t-test and tests of proportions were used for comparison with significance at p < 0.05.

RESULTS

The mean age of patients was 38.4 ±16.2 years in G1 and 35.1 ±18.6 years in G2. In G1, 34 cases were traumatic, 5 caused by diabetic ulcers and another 7 cases were trophic ulcers in paraplegic patients caused by pressure sores. In G2, the cause was trauma in 32 cases, diabetic ulcers in 7 cases, trophic ulcers in 2 cases. The mean number of surgeries in G1 was 3 ±1 and 2 ±1 in G2 (p < 0.001). The mean hospital stay in G1 was 43.1 ±3.6 days while 27.9 ±2.1 days in G2 (p < 0.001). There was epidermolysis in 21 out of 46 islanded distally based sural artery flaps (G1) and in 9 out of 41 non-islanded flaps (G2) (p=0.0203). Partial necrosis occurred in 12 of flaps in G1 and in only 3 of G2 flaps (p=0.024).

CONCLUSION

Distally based sural artery flap can be made more reliable and with lesser complications by raising the pedicle with skin rather than islanding the flap.

摘要

目的

评估非岛状远端蒂腓肠动脉皮瓣在覆盖小腿下三分之一、踝关节和足跟软组织缺损方面的可靠性，具体指标包括皮瓣失败（部分和大面积皮瓣坏死）的数量、因皮瓣手术所针对问题而进行的手术数量、住院时间和恢复工作情况。

研究设计

队列研究。

研究地点和时间

2003年1月至2014年3月，巴基斯坦拉合尔真纳爱德华国王医科大学梅奥医院整形外科和烧伤科。

方法

对87例需要覆盖下肢远端的患者进行回顾性研究，采用远端蒂腓肠动脉皮瓣。患者分为两组。G1组包括46例采用岛状远端蒂腓肠动脉皮瓣的病例。G2组包括41例未采用岛状皮瓣而是掀起蒂部的病例。两组测量的变量包括年龄、性别、缺损大小和原因、合并症、手术次数、总住院时间、恢复工作情况以及皮瓣相关并发症。采用独立样本t检验和比例检验进行比较，显著性水平为p<0.05。

结果

G1组患者的平均年龄为38.4±16.2岁，G2组为35.1±18.6岁。在G1组中，34例为创伤性损伤，5例由糖尿病溃疡引起，另外7例为截瘫患者因压疮导致的营养性溃疡。在G2组中，32例为创伤性损伤，7例为糖尿病溃疡，2例为营养性溃疡。G1组的平均手术次数为3±1次，G2组为2±1次（p<0.001）。G1组的平均住院时间为43.1±3.6天，G2组为27.9±2.1天（p<0.001）。46例岛状远端蒂腓肠动脉皮瓣（G1组）中有21例发生表皮松解，41例非岛状皮瓣（G2组）中有9例发生表皮松解（p=0.0203）。G1组12例皮瓣发生部分坏死，G2组仅3例皮瓣发生部分坏死（p=0.024）。