Department of Traumatic Orthopedics, Wuxi Ninth People's Hospital affiliated to Soochow University, NO.999 Liangxi Road, Wuxi City, 214062, Jiangsu Province, China.
Orthopaedic Institute, Wuxi Ninth People's Hospital affiliated to Soochow University, Wuxi, Jiangsu, China.
J Orthop Surg Res. 2020 Apr 7;15(1):134. doi: 10.1186/s13018-020-01647-0.
Despite advances in microsurgical techniques of flap transfer, complex upper extremity trauma reconstruction remains a challenge for surgeons. This study aimed to present the outcomes in using flaps in the subacute reconstruction of complex upper extremity injuries.
From July 2013 to December 2016, 35 patients ranging in age from 23 to 69 years with complicated upper extremity traumatic injuries were treated using flap reconstruction in subacute period. The number and causes of injury were 12 machine crush injuries, 18 machine strangulation injuries, two chainsaw accidents, two traffic accidents, and one incident of heavy bruising. Thirty-five patients underwent flap procedures, including 24 anterolateral thigh flaps (68.57%), five latissimus dorsi flaps (14.29%), and six lateral arm flaps (17.14%). Flap sizes ranged from 3 × 4 to 42 × 16 cm. The mean time of flap reconstruction was 14 days (range 5-29). During postoperative follow-up, flap appearance, sensory recovery, scarring and satisfaction were assessed.
The overall flap survival rate was 94.3%.Two flaps developed partial necrosis, both of which were later treated with skin grafting. Traumatic wound infections occurred in three patients. All upper limb injuries were completely covered. The follow-up periods ranged from 18 to 62 months with an average of 2.9 months. All skin flap textures were soft with varying degrees of pigmentation. Flap sensory recovery was S in three cases, S in eight cases, S in 15 cases, and S in nine cases. There were no donor site complications other than three cases with scar hyperplasia.
The severe upper limb soft tissue defects still achieved satisfactory function and appearance with negligible complications and low amputation rates during the subacute period.
尽管皮瓣转移的显微外科技术取得了进步，但复杂上肢创伤的重建仍然是外科医生面临的挑战。本研究旨在介绍在复杂上肢损伤的亚急性期使用皮瓣进行重建的结果。
2013 年 7 月至 2016 年 12 月，35 例年龄 23 至 69 岁的复杂上肢创伤患者在亚急性期接受皮瓣重建治疗。损伤的数量和原因分别为 12 例机器挤压伤、18 例机器绞轧伤、2 例链锯伤、2 例交通事故和 1 例严重挫伤。35 例患者接受了皮瓣手术，其中包括 24 例股前外侧皮瓣（68.57%）、5 例背阔肌皮瓣（14.29%）和 6 例侧臂皮瓣（17.14%）。皮瓣大小为 3×4 至 42×16cm。皮瓣重建的平均时间为 14 天（范围 5-29 天）。术后随访评估皮瓣外观、感觉恢复、瘢痕和满意度。
总的皮瓣存活率为 94.3%。2 个皮瓣发生部分坏死，均行植皮治疗。3 例患者发生创伤性伤口感染。所有上肢损伤均完全覆盖。随访时间为 18 至 62 个月，平均 2.9 个月。所有皮瓣质地柔软，色素沉着程度不同。皮瓣感觉恢复为 S₃ 的 3 例，S₃的 8 例，S₁+的 15 例，S₂的 9 例。除 3 例有瘢痕增生外，无供区并发症。
在亚急性期，严重的上肢软组织缺损仍能获得满意的功能和外观，并发症少，截肢率低。
