Liu F, Zhang W, Xie W G, Chen L, Zhang W D, Zhou J X, Li Z
Department of Burns, Tongren Hospital of Wuhan University & Wuhan Third Hospital, Wuhan 430060, China.
Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2023 Oct 20;39(10):933-938. doi: 10.3760/cma.j.cn501225-20230701-00244.
To investigate the effects of miniature free groin perforator flaps in repairing small wounds on hands. The retrospective observational study was conducted. Fifteen patients with 16 small wounds on hands were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital from July 2020 to October 2022, including 12 males and 3 females, aged 19 to 56 years. The size of skin and soft tissue defect was 2.0 cm×1.5 cm to 6.0 cm×3.0 cm after debridement. According to size and shape of the wounds, 13 single-lobe perforator flaps and 2 bilobed perforator flaps were designed in the groin region, with the flap size of 4.5 cm×2.5 cm to 7.5 cm×3.5 cm. According to the condition of the recipient area, the arteries and veins at the pedicle of the flap were anastomosed to the arteries and veins of the recipient area respectively. The wounds in the donor area of the flap was closed by layered and tension-reducing suture. The thickness of the flap was measured during operation. The survival of the flap was observed, and the complications in the donor and recipient areas were recorded after operation. The appearance and texture of the flap were observed during follow-up. At the last follow-up, the sensory recovery of the affected hand was evaluated, the function of the affected hand was evaluated according to the trial standard of the upper limb partial function evaluation of the Hand Surgery Society of the Chinese Medical Association, the scar in the donor and recipient areas were observed, and the satisfaction of patients for the curative effects was inquired. The thickness of the flap was ranged from 0.3 to 1.0 cm, with an average thickness of 0.6 cm. After operation, 11 single-lobe flaps and 2 bilobed flaps survived well; in the left 2 single-lobe flaps, one flap had venous crisis but returned to normal after removing stitches to reduce tension and bloodletting of flaps, while the other one flap had a little necrosis on tip but healed after dressing change. No complications occurred in donor and recipient areas. During follow-up of 8 to 35 months after operation, the flaps had good elasticity and soft texture; 8 flaps were slightly bloated and were trimmed 3 to 8 months after operation, while the appearances of the other flaps were good. At the last follow-up, all flaps recovered protective feeling; the function of the affected hand was evaluated as excellent in 10 cases, good in 4 cases, and fair in 1 case; only linear scar remained in the donor and recipient areas; the patients were satisfied with the appearance and function recovery of the affected hand. The miniature free groin perforator flaps in repairing small wounds on hands have the advantages of high survival rate of flaps, hidden flap donor area, little damage, few complications, good repair effect, etc., showing clinical application value. It is recommended for repairing non-functional wounds on hands.
探讨微型游离腹股沟穿支皮瓣修复手部小创面的效果。进行回顾性观察研究。2020年7月至2022年10月，武汉大学同仁医院暨武汉市第三医院收治手部小创面患者15例，共16处创面，其中男12例，女3例，年龄19～56岁。清创后皮肤软组织缺损大小为2.0 cm×1.5 cm至6.0 cm×3.0 cm。根据创面大小和形状，在腹股沟区设计单叶穿支皮瓣13例、双叶穿支皮瓣2例，皮瓣大小为4.5 cm×2.5 cm至7.5 cm×3.5 cm。根据受区情况，将皮瓣蒂部动静脉分别与受区动静脉吻合。皮瓣供区创面采用分层减张缝合关闭。术中测量皮瓣厚度。观察皮瓣成活情况，术后记录供受区并发症。随访期间观察皮瓣外观及质地。末次随访时，评估患手感觉恢复情况，按照中华医学会手外科学会上肢部分功能评定试用标准评估患手功能，观察供受区瘢痕情况，询问患者对疗效的满意度。皮瓣厚度为0.3～1.0 cm，平均厚度0.6 cm。术后11例单叶皮瓣、2例双叶皮瓣成活良好；2例单叶皮瓣中，1例皮瓣发生静脉危象，拆除缝线减轻皮瓣张力及放血后恢复正常，另1例皮瓣尖端少许坏死，换药后愈合。供受区均未发生并发症。术后8～35个月随访，皮瓣弹性好、质地柔软；8例皮瓣轻度臃肿，于术后3～8个月修整，其余皮瓣外观良好。末次随访时，所有皮瓣均恢复保护性感觉；患手功能评定：优10例，良4例，可1例；供受区仅留线性瘢痕；患者对患手外观及功能恢复满意。微型游离腹股沟穿支皮瓣修复手部小创面具有皮瓣成活率高、供区隐蔽、损伤小、并发症少、修复效果好等优点，具有临床应用价值，推荐用于修复手部非功能创面。
