Li Ze, Zhang Wei, Yang Fei, Zhang Weidong, Chen Lan, Liu Feng, Liu Shuhua, Xie Weiguo
Department of Burns, Tongren Hospital of Wuhan University & Wuhan Third Hospital, Wuhan Hubei, 430060, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 May 15;39(5):633-638. doi: 10.7507/1002-1892.202503130.
To explore the effectiveness of free paraumbilical perforator flaps in repairing skin and soft tissue defects in children.
Between February 2018 and March 2024, 12 children with skin and soft tissue defects were treated with the free paraumbilical perforator flaps. There were 7 boys and 5 girls with an average age of 6.3 years (range, 2-12 years). The defects located on the upper limbs in 6 cases, lower limbs in 5 cases, and neck in 1 case. The causes of wounds included 7 cases of electrical burns, 1 case of thermal burn, 2 cases of scar release and excision due to scar contraction after burns, 1 case of scar ulcer at the amputation stump after severe burns, and 1 case of skin necrosis after a traffic accident injury. The size of defects after debridement ranged from 7.0 cm×4.0 cm to 18.0 cm×10.0 cm. According to the defect size, 11 cases were repaired with unilateral paraumbilical perforator flaps centered on the umbilicus, among which 3 cases with larger defects were designed as "L"-shaped flaps along the lateral and lower ends of the perforator; the donor sites were directly closed. One case with extensive defect after scar excision and release was repaired with bilateral expanded paraumbilical perforator flaps; the donor sites were repaired with autologous split-thickness skin grafts. The size of flaps ranged from 9.0 cm×4.0 cm to 20.0 cm×11.0 cm. Postoperatively, analgesia and sedation were provided, and the blood supply of the flaps was observed.
All operations were successfully completed. The operation time was 4-7 hours, with an average of 5.0 hours. After postoperative analgesia and sedation, the visual analogue scale (VAS) score for pain in all children was less than or equal to 3, and there was no non-cooperation due to pain. All flaps and skin grafts survived completely, and the wounds healed by first intention. Ten children underwent 1-4 times of flap de-fatting, finger separation, and trimming. All children were followed up 6-48 months (mean, 26.6 months). No obvious swelling of the flaps occurred, and the texture was soft. At last follow-up, among the 6 children with upper limb defects, 2 had upper limb function grade Ⅳ and 4 had upper limb function grade Ⅴ according to the Carroll upper limb function assessment method. The 4 children with lower limb defects had no limitation of joint movement. The neck flexion and rotation in the 1 child with neck defect significantly improved when compared with that before operation. The 1 child with residual ulcer at the amputation stump could wear a prosthesis and move without limitation, and no new ulcer occurred. Linear scars were left at the donor sites, and no abdominal wall hernia was formed.
The free paraumbilical perforator flap has abundant blood supply and can be harvested in large size. It can be used to repair skin and soft tissue defects in children and has the advantages of short operation time, minimal injury, high safety, and minimal impact on the growth and development of children.
探讨游离脐旁穿支皮瓣修复儿童皮肤软组织缺损的有效性。
2018年2月至2024年3月，对12例皮肤软组织缺损患儿采用游离脐旁穿支皮瓣治疗。其中男7例，女5例，平均年龄6.3岁（范围2～12岁）。缺损位于上肢6例，下肢5例，颈部1例。创面原因包括电烧伤7例，热烧伤1例，烧伤后瘢痕挛缩行瘢痕松解切除2例，重度烧伤截肢残端瘢痕溃疡1例，交通事故伤后皮肤坏死1例。清创后缺损大小为7.0 cm×4.0 cm至18.0 cm×10.0 cm。根据缺损大小，11例采用以脐为中心的单侧脐旁穿支皮瓣修复，其中3例缺损较大者沿穿支外侧及下端设计为“L”形皮瓣；供区直接缝合。1例瘢痕切除松解后缺损广泛者采用双侧扩张脐旁穿支皮瓣修复；供区采用自体中厚皮片移植修复。皮瓣大小为9.0 cm×4.0 cm至20.0 cm×11.0 cm。术后给予镇痛镇静，观察皮瓣血运情况。
所有手术均顺利完成。手术时间4～7小时，平均5.0小时。术后经镇痛镇静，所有患儿疼痛视觉模拟评分（VAS）均≤3分，无因疼痛不配合情况。所有皮瓣及植皮全部成活，创面一期愈合。10例患儿行1～4次皮瓣去脂、分指及修整。所有患儿随访6～48个月（平均26.6个月）。皮瓣无明显肿胀，质地柔软。末次随访时，6例上肢缺损患儿中，按卡罗尔上肢功能评估法，上肢功能Ⅳ级2例，Ⅴ级4例。4例下肢缺损患儿关节活动无受限。1例颈部缺损患儿颈部屈伸及旋转功能较术前明显改善。1例截肢残端残留溃疡患儿佩戴假肢活动不受限，未出现新的溃疡。供区遗留线性瘢痕，未形成腹壁疝。
游离脐旁穿支皮瓣血供丰富，可切取面积大，可用于修复儿童皮肤软组织缺损，具有手术时间短、创伤小、安全性高、对儿童生长发育影响小等优点。
