Ou Changliang, Luo Xuchao, Zhou Xin, Zou Yonggen, Li Jiayu, Yang Yingqiu
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Department of Orthopedics, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Sep 15;36(9):1150-1154. doi: 10.7507/1002-1892.202204071.
To investigate the effectiveness of free superficial circumflex iliac artery flap (SCIP) combined with deep inferior epigastric perforator flap (DIEP) in repairing large soft tissue defects of upper extremities.
Between February 2017 and January 2021, free SCIP combined with DIEP was used to repair 15 patients with large soft tissue defects of upper extremities. There were 12 males and 3 females, aged from 34 to 52 years, with a median age of 41 years. The causes of injury were mechanical injury in 11 cases and traffic accident injury in 4 cases. There were 9 cases of circular skin defect in the forearm and 6 cases of skin defect around the upper arm and elbow joint, with the defect in size of 15.5 cm×10.5 cm to 26.5 cm×15.5 cm, accompanied by exposure of deep tissues such as tendons and bones. There were 7 cases with open fractures and 8 cases with vascular and nerve injuries. The time from injury to operation ranged from 7 to 14 days, with an average of 7.5 days. The flaps in size of 16.0 cm×11.0 cm to 27.0 cm×16.0 cm were harvested; the thickness of the flaps was 0.8-1.3 cm, and the excess fat tissue was removed under the microscope after harvesting. The length of proximal vascular pedicle was 5.0-7.0 cm, and of distal vascular pedicle was 3.0-5.0 cm. The donor site was closed and sutured directly, and the navel was reconstructed.
The flaps survived successfully in 14 cases, and the arterial crisis occurred in 1 case at 10 hours after operation, and the flap survived after surgical exploration. All the wounds in the donor and recipient sites healed by first intention. All 15 patients were followed up 3-14 months, with an average of 10.5 months. The appearance, elasticity, and texture of flap were good without obvious bloat, contracture, or adhesion. The donor site healed well, no abdominal wall hernia was found, and the appearance of reconstructed navel was good, only linear scar left. At last follow-up, 12 cases were evaluated as excellent and 3 cases were good according to the evaluation criteria of flap function of the Chinese Medical Association Microsurgery Branch. The sensation recovered to in 7 cases and in 8 cases.
Free SCIP combined with DIEP has a large excision area and excellent skin ductility. It is an effective clinical method for repairing large soft tissue defects of upper extremities.
探讨游离旋髂浅动脉皮瓣（SCIP）联合腹壁下深动脉穿支皮瓣（DIEP）修复上肢大面积软组织缺损的疗效。
2017年2月至2021年1月，采用游离SCIP联合DIEP修复15例上肢大面积软组织缺损患者。其中男12例，女3例，年龄34～52岁，中位年龄41岁。致伤原因：机械伤11例，交通事故伤4例。前臂环形皮肤缺损9例，上臂及肘关节周围皮肤缺损6例，缺损面积为15.5 cm×10.5 cm至26.5 cm×15.5 cm，伴有肌腱、骨骼等深部组织外露。开放性骨折7例，血管、神经损伤8例。受伤至手术时间7～14天，平均7.5天。切取皮瓣大小为16.0 cm×11.0 cm至27.0 cm×16.0 cm；皮瓣厚度0.8～1.3 cm，切取后在显微镜下切除多余脂肪组织。近端血管蒂长5.0～7.0 cm，远端血管蒂长3.0～5.0 cm。供区直接缝合关闭，重建脐部。
14例皮瓣顺利成活，1例术后10小时发生动脉危象，经手术探查后皮瓣成活。供区和受区伤口均一期愈合。15例患者均获随访，时间3～14个月，平均10.5个月。皮瓣外观、弹性及质地良好，无明显臃肿、挛缩或粘连。供区愈合良好，未发现腹壁疝，重建脐部外观良好，仅留线状瘢痕。末次随访时，根据中华医学会显微外科学分会皮瓣功能评价标准，优12例，良3例。7例感觉恢复至 ，8例感觉恢复至 。
游离SCIP联合DIEP切取面积大，皮肤延展性好，是修复上肢大面积软组织缺损的有效临床方法。
