带蒂髂腹部真皮下血管网皮瓣修复手前臂软组织缺损(1)
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[摘要]目的：探讨带蒂髂腹部真皮下血管网皮瓣修复手前臂软组织缺损的应用价值。方法：2008年8月至2011年1月，对16例手前臂软组织缺损的患者应用带蒂髂腹部真皮下血管网皮瓣进行修复，皮瓣面积9.0cm×5.0cm～15.0cm×20.0cm。供瓣区直接缝合。术后7～18天断蒂。结果：16例皮瓣全部成活，1例皮瓣远端起水疱，表皮坏死脱落，经换药自行愈合。10例获得3～10个月随访，皮瓣外形美观，无继发挛缩，受区外形和患肢功能恢复较满意。结论：带蒂髂腹部真皮下血管网皮瓣血供可靠，应用形式灵活多样，是修复手前臂软组织缺损的一种较理想选择。
[关键词]外科皮瓣；真皮下血管网；手；软组织缺损
[中图分类号]R622[文献标识码]A[文章编号]1008-6455(2011)07-1056-03
Treatment of soft tissue defects in hands and forearms by subcutaneous vascular net flap from lower abdomen
LIU Wen-jian1,WEN Hui-cai2,FU Jian-hua2,YAO Yu-ting2,YANG Hong-hua2
(1.Department of Burns and Plasty,Jiangxi Provincial Corps Hospital,Chinese People's Armed Police Forces,Nanchang 330030,Jiangxi,China;2.Department of Plastic and Aestletic,The Affiliated Hospital,Nanchang University)
Abstract:ObjectiveTo investigate the application of subcutaneous vascular net flap from lower abdomen for soft tissue defects in hands and forearms.MethodsFrom August 2008 to January 2010, 16 cases with soft tissue defects in hands and forearms were treated using subcutaneous vascular net flap from lower abdomen,flap size ranged from 9.0cm×5.0cm to 15.0cm×20.0cm.The defects in lower abdomen were closed directly.7～18 days postopration,cut off the pedicles.ResultsFlaps all survived,all wounds were primarily healed.1 cases suffered delaying healing because of flap epidermis necrosis of the distal part.10 cases were followed up for 3 to 9 months with satisfactory aesthetic and functional results in the recipient areas,no contracture appearance.ConclusionsThe subcutaneous vascular net flap from lower abdomen has rich blood supply and great flexibility,which is practical and suitable for repair of soft tissue defects in hands and forearms.
Keywords:surgical flaps；subcutaneous vascular net；hand；soft tissue defect
手和前臂是人体的暴露部位和劳动器官，常因遭受各种外伤(包括撕脱伤、烧伤、挤压伤等)或后期整复导致皮肤软组织缺损，严重时伴有神经血管束、肌腱或骨关节外露、损伤或缺损，因对功能和外形要求高，其修复比较棘手。2008年8月～2011年1月，笔者采用髂腹部真皮下血管网皮瓣修复手前臂软组织缺损16例，获得满意效果。
1资料和方法
1.1 应用解剖：腹壁浅动脉发自股动脉，发出点位于腹股沟以下约5.0cm，分为内、外侧主支。内侧主支在股动脉起点下约2.5cm处，穿出阔筋膜进入浅层，经腹股沟韧带浅面进入腹壁，主要分布于同侧下腹部内侧半皮肤。外侧主支出现率为66%，在股动脉起点下约1.0cm处穿深筋膜进入浅层，跨过腹股沟韧带进入腹壁，主要分布下腹部外侧半皮肤。旋髂浅动脉与腹壁浅动脉约同一水平自股动脉或共干发出，向髂前上棘方向行走很快浅出，主要分布下腹部外侧和股前部上份的皮肤。两组血管均有伴行静脉，分支之间有丰富的吻合交通。同时与腹壁下动脉穿支、肋下动脉、胸外侧动脉及腰动脉等皮支吻合[1]。
1.2 临床资料：本组16例，男13例，女3例，年龄8～46岁。致伤原因：撕脱伤7例，脱套伤1例，电击伤2例 ......
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