Liu Y Y, Wu M, Zhu J, Zhang K K, Niu H Z, Gao X B, Han Z B, Liu F D
Department of Hand and Foot Microsurgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China.
Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2024 Jan 20;40(1):72-77. doi: 10.3760/cma.j.cn501225-20230727-00018.
To investigate the clinical effects of free superficial circumflex iliac artery (SCIA) superficial branch perforator flap combined with full-thickness skin graft far from the flap donor site in repairing the large wounds in extremities. The study was a retrospective observational study. From January 2020 to June 2022, 19 patients with large wounds in extremities who met the inclusion criteria were admitted to the First Affiliated Hospital of Bengbu Medical College, including 15 males and 4 females, aged 28-75 years. The debridement, fracture reduction and fixation, tendon, vessel, and nerve repair, and vacuum sealing drainage were performed in the first stage surgery. After debridement in the second stage surgery, the total wound area was 13.0 cm×8.0 cm-34.0 cm×15.0 cm. The tendon and bone exposed wound with area of 9.0 cm×6.0 cm-14.0 cm×7.0 cm was repaired with free SCIA superficial branch perforator flap with area of 10.0 cm×6.5 cm-15.0 cm×8.0 cm. The remaining granulation tissue wound with area of 5.0 cm×3.5 cm-13.0 cm×8.0 cm was repaired with full-thickness skin graft far from the flap donor site with area of 5.0 cm×3.5 cm-13.0 cm×8.0 cm. All the wounds in donor site were sutured. The operation time and amount of bleeding of patients during the surgery were recorded, the survival of flap and skin graft were observed after surgery. During follow-up, the flap and skin graft, scar in the donor site and its effect on donor site function were observed. At the last follow-up, the satisfaction of patients with the efficacy was evaluated by the efficacy satisfaction rating score. The operation time of patients was 2.0-3.5 h. The amount of bleeding of patients during the surgery was 100-320 mL. One patient had ecchymosis and venous crisis in the edge of flap on the second day after surgery, and the flap survived after exploration. The flaps of the other patients survived smoothly. The skin grafts of patients all survived smoothly. Two patients had bloated flaps due to obesity in the later stage, and the expected results were achieved after flap thinning surgery 6 months after operation. During the follow-up of 6 to 24 months, the flaps had good elasticity and soft texture, and the skin grafts had no wear or ulceration; linear scars were left in all the donor sites but their functions were not affected. The patients were all satisfied with the efficacy. Free SCIA superficial perforator flap combined with full-thickness skin graft far from the donor site was used to repair the large wounds in extremities, which was safe, reliable, and less traumatic and short in operation time, and resulted in good postoperative appearance and function in the donor sites and recipient sites.
探讨游离旋髂浅动脉（SCIA）浅支穿支皮瓣联合远离皮瓣供区的全厚皮片移植修复四肢大面积创面的临床效果。本研究为回顾性观察性研究。2020年1月至2022年6月，蚌埠医学院第一附属医院收治符合纳入标准的四肢大面积创面患者19例，其中男性15例，女性4例，年龄28～75岁。一期手术进行清创、骨折复位固定、肌腱、血管及神经修复，并进行封闭负压引流。二期手术清创后，创面总面积为13.0 cm×8.0 cm～34.0 cm×15.0 cm。面积为9.0 cm×6.0 cm～14.0 cm×7.0 cm的肌腱及骨外露创面采用面积为10.0 cm×6.5 cm～15.0 cm×8.0 cm的游离SCIA浅支穿支皮瓣修复。剩余面积为5.0 cm×3.5 cm～13.0 cm×8.0 cm的肉芽组织创面采用面积为5.0 cm×3.5 cm～13.0 cm×8.0 cm的远离皮瓣供区的全厚皮片移植修复。供区所有创面均予以缝合。记录患者手术时间及术中出血量，术后观察皮瓣及皮片存活情况。随访期间，观察皮瓣及皮片、供区瘢痕及其对供区功能的影响。末次随访时，采用疗效满意度评分评价患者对疗效的满意度。患者手术时间为2.0～3.5小时。术中出血量为100～320 mL。1例患者术后第2天皮瓣边缘出现瘀斑及静脉危象，经探查后皮瓣存活。其他患者皮瓣均顺利存活。患者皮片均顺利存活。2例患者后期因肥胖出现皮瓣臃肿，术后6个月行皮瓣修薄术后达到预期效果。随访6～24个月，皮瓣弹性好、质地柔软，皮片无磨损及溃疡；所有供区均遗留线状瘢痕，但功能未受影响。患者对疗效均满意。游离SCIA浅支穿支皮瓣联合远离供区的全厚皮片移植修复四肢大面积创面安全可靠，创伤小，手术时间短，供区及受区术后外形及功能良好。
