Teven Chad M, Mhlaba Julie, O'Connor Annemarie, Gottlieb Lawrence J
From the Burn and Complex Wound Center, Section of Plastic & Reconstructive Surgery, The University of Chicago Medicine, Illinois.
J Burn Care Res. 2017 Jan/Feb;38(1):20-27. doi: 10.1097/BCR.0000000000000447.
The majority of surgical burn care involves the use of skin grafts. However, there are cases when flaps are required or provide superior outcomes both in the acute setting and for postburn reconstruction. Rarely discussed in the context of burn care, the perforator-based propeller flap is an important option to consider. We describe our experience with perforator-based propeller flaps in the acute and reconstructive phases of burn care. We reviewed demographics, indications, operative details, and outcomes for patients whose burn care included the use of a perforator-based propeller flap at our institution from May 2007 to April 2015. Details of the surgical technique and individual cases are also discussed. Twenty-one perforator-based propeller flaps were used in the care of 17 burn patients. Six flaps (29%) were used in the acute phase for coverage of exposed joints, tendons, cartilage, and bone; coverage of open wounds; and preservation of range of motion (ROM) by minimizing scar contracture. Fifteen flaps (71%) were used for reconstruction of postburn deformities including coverage of chronic wounds, for coverage after scar contracture release, and to improve ROM. The majority of flaps (94% at follow-up) exhibited stable soft tissue coverage and good or improved ROM of adjacent joints. Three cases of partial flap loss and one case of total flap loss occurred. Perforator-based propeller flaps provide reliable vascularized soft tissue for coverage of vital structures and wounds, contracture release, and preservation of ROM across joints. Despite a relatively significant risk of minor complications particularly in the coverage of chronic wounds, our study supports their utility in both the acute and reconstructive phases of burn care.
大多数烧伤手术治疗都涉及皮肤移植。然而,在某些情况下,无论是在急性期还是烧伤后重建阶段,皮瓣都是必需的或能带来更好的治疗效果。基于穿支的推进皮瓣在烧伤护理背景下很少被讨论,但却是一个值得考虑的重要选择。我们描述了在烧伤护理的急性期和重建期使用基于穿支的推进皮瓣的经验。我们回顾了2007年5月至2015年4月在我们机构接受烧伤护理且使用了基于穿支的推进皮瓣的患者的人口统计学资料、适应症、手术细节和治疗结果。还讨论了手术技术细节和个别病例。17例烧伤患者接受了21个基于穿支的推进皮瓣治疗。6个皮瓣(29%)在急性期用于覆盖暴露的关节、肌腱、软骨和骨骼;覆盖开放性伤口;以及通过最小化瘢痕挛缩来保留关节活动范围(ROM)。15个皮瓣(71%)用于烧伤后畸形的重建,包括覆盖慢性伤口、瘢痕挛缩松解后的覆盖以及改善ROM。大多数皮瓣(随访时为94%)表现出稳定的软组织覆盖以及相邻关节良好或改善的ROM。发生了3例部分皮瓣丢失和1例完全皮瓣丢失。基于穿支的推进皮瓣为重要结构和伤口的覆盖、挛缩松解以及关节ROM的保留提供了可靠的带血管软组织。尽管存在相对较高的轻微并发症风险,尤其是在覆盖慢性伤口时,但我们的研究支持其在烧伤护理的急性期和重建期的应用价值。
J Burn Care Res. 2017
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