Reid R
Sinai Hospital, and Wayne State University School of Medicine, Detroit, Michigan, USA.
Am J Obstet Gynecol. 1997 Dec;177(6):1372-83; discussion 1383-4. doi: 10.1016/s0002-9378(97)70078-4.
The purpose of this study was to evaluate the safety and efficacy of skin flaps in vulvar reconstructive surgery.
A retrospective review was performed on 207 consecutive flaps on 191 assessable women referred between 1992 and 1996. Outcome measures were wound closure, healing, restoration of coital function, and final result after any secondary revision.
Primary closure without tension was possible in all but one instance, and 186 (89.9%) wounds healed by primary intention. Of 146 contractures, 95.8% were reparable by simple sliding flaps (YV advancement or "maple leaf"). Conversely, all the 99 tissue deficits required a pivoting design (random transposition, Martius, pudendal thigh, and gracilis or gluteus myocutaneous flaps). Primary success rates decreased sharply with worsening deformity, underlying disease, and complexity of flap design. There were 65 complications among 42 individuals, and 21 women required subsequent Z plasty or a second flap. Nonetheless, disease was cured and function restored in 178 (93.2%) patients.
Sliding or pivoting vulvar flaps are generally reliable. Complex flaps are more difficult, but there are seldom any simpler surgical options.
本研究旨在评估皮瓣在外阴重建手术中的安全性和有效性。
对1992年至1996年间转诊的191例可评估女性患者连续实施的207例皮瓣手术进行回顾性研究。观察指标包括伤口闭合、愈合情况、性交功能恢复以及任何二次修复后的最终结果。
除1例之外，其余所有病例均实现了无张力一期缝合，186例（89.9%）伤口一期愈合。在146例挛缩病例中，95.8%可通过简单的滑行皮瓣（Y-V推进或“枫叶”皮瓣）修复。相反，所有99例组织缺损均需要采用旋转皮瓣设计（随意转移、马蒂厄皮瓣、阴部大腿皮瓣以及股薄肌或臀大肌肌皮瓣）。随着畸形加重、基础疾病以及皮瓣设计复杂性增加，一期成功率急剧下降。42例患者出现65例并发症，21例女性患者需要后续进行Z成形术或二次皮瓣手术。尽管如此，178例（93.2%）患者的疾病得到治愈，功能得以恢复。
滑行或旋转外阴皮瓣通常是可靠的。复杂皮瓣难度更大，但很少有更简单的手术选择。
