改良拱顶石皮瓣在关节部位皮肤软组织缺损修复中的应用
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摘要
目的探讨改良拱顶石皮瓣修复关节及其邻近部位皮肤软组织缺损的临床效果。方法 2013年3月—2017年12月,采用改良拱顶石皮瓣修复10例关节部位皮肤软组织缺损。男6例,女4例;年龄17～72岁,平均57.5岁。均为关节活动部位软组织,其中髋关节2例,膝关节4例,肘关节3例,腕关节1例。软组织缺损原因:瘢痕挛缩切除后3例,基底细胞癌3例,鳞状细胞癌3例,皮肤隆突性纤维肉瘤1例。软组织缺损范围4 cm×3 cm～11 cm×11 cm。紧邻创面设计拱顶石皮瓣,在创面对侧皮瓣底边处设计V形皮瓣。皮瓣切取范围7 cm×3 cm～35 cm×10 cm。术后皮瓣移植区进行持续负压吸引3～6 d。结果术后皮瓣顺利成活,切口均Ⅰ期愈合。患者均获随访,随访时间6～24个月,平均15个月。皮瓣移植区皮肤质地、颜色与邻近区域近似,关节活动度良好。患者对功能及形态均较满意。结论改良拱顶石皮瓣修复关节部位皮肤软组织缺损操作简便,愈合后软组织厚度、肤色与周围皮肤相似,关节功能不受限,是一种安全、有效的治疗方法。
Objective To explore the effectiveness of keystone flap in repairing skin and soft tissue defects around joint. Methods Between March 2013 and December 2017, 10 patients of skin and soft tissue defects around the joint were repaired with keystone flaps. There were 6 males and 4 females. The age ranged from 17 to 72 years, with an average age of 57.5 years. The skin and soft tissue defects located around the joints, including 2 cases of hip joints, 4 cases of knee joints, 3 cases of elbow joints, and 1 case of wrist joint. The cause of skin and soft tissue defects included scar contracture in3 cases, basal cell carcinoma in 3 cases, squamous-cell carcinoma in 3 cases, and dermatofibrosarcoma protuberant in1 case. The area of defects ranged from 4 cm×3 cm to 11 cm×11 cm. The keystone flap was designed beside the wound,and the V-shaped flap was designed at the longer side of the fan-shaped flap. The area of flap ranged from 7 cm×3 cm to 35 cm×10 cm. The flap was constantly compressed by vacuum assisted closure after operation for 3-6 days. Results Primary wound healing was achieved and the flaps survived. All patients were followed up 6-24 months(mean, 15 months). The texture and color of flap was similar to the adjacent area. The appearance and function of joint were satisfactory.Conclusion The keystone flap is a feasible and efficient way to repair the wound around joint. Furthermore, the skin color and texture is similar to the surrounding tissue after healing.
Objective To explore the effectiveness of keystone flap in repairing skin and soft tissue defects around joint. Methods Between March 2013 and December 2017, 10 patients of skin and soft tissue defects around the joint were repaired with keystone flaps. There were 6 males and 4 females. The age ranged from 17 to 72 years, with an average age of 57.5 years. The skin and soft tissue defects located around the joints, including 2 cases of hip joints, 4 cases of knee joints, 3 cases of elbow joints, and 1 case of wrist joint. The cause of skin and soft tissue defects included scar contracture in3 cases, basal cell carcinoma in 3 cases, squamous-cell carcinoma in 3 cases, and dermatofibrosarcoma protuberant in1 case. The area of defects ranged from 4 cm×3 cm to 11 cm×11 cm. The keystone flap was designed beside the wound,and the V-shaped flap was designed at the longer side of the fan-shaped flap. The area of flap ranged from 7 cm×3 cm to 35 cm×10 cm. The flap was constantly compressed by vacuum assisted closure after operation for 3-6 days. Results Primary wound healing was achieved and the flaps survived. All patients were followed up 6-24 months(mean, 15 months). The texture and color of flap was similar to the adjacent area. The appearance and function of joint were satisfactory.Conclusion The keystone flap is a feasible and efficient way to repair the wound around joint. Furthermore, the skin color and texture is similar to the surrounding tissue after healing.
引文
1 Shin YH, Hwang PJ, Hwang K. V-Y and rotation flap for reconstruction of the epicanthal fold. J Craniofac Surg, 2012, 23(4):e278-e280.
2蒋丽雅,刘元波,臧梦青,等.以旋股外侧动脉斜支为蒂的逆行股前外侧皮瓣临床应用研究.中国修复重建外科杂志,2017, 31(5):559-563.
3朱跃良,殷作明,王家祥,等.股前外侧穿支皮瓣切取技巧分析.中国修复重建外科杂志,2017, 31(1):57-61.
4 Behan FC. The keystone design perforator island flap in reconstructive surgery. ANZ J Surg, 2003, 73(3):112-120.
5邹平志,刘斌,姜任武,等.改良拱顶石皮瓣在头皮软组织缺损修复中的应用.中国美容整形外科杂志,2017, 28(10):602-603.
6 Park HS, Morrison E, Lo C, et al. An application of keystone perforator island flap for closure of lumbosacral myelomeningocele defects. Ann Plast Surg, 2015, 77(3):332-336.
7沈顺,杨超,邢新,等.改良拱顶石穿支岛状皮瓣在肛周缺损修复中的应用.中国美容整形外科杂志,2016, 27(9):532-535.
8刘伟峰,刘斌,姜任武,等.拱顶石皮瓣在足部皮肤软组织缺损修复中的应用.中国美容整形外科杂志,2016, 27(10):622-623.
9杨超,邢新,徐建国,等.拱顶石穿支岛状皮瓣在皮肤软组织缺损修复中的应用.中华整形外科杂志,2014, 30(1):10-13.
10方硕,杨超,邢新.拱顶石穿支岛状皮瓣.中华整形外科杂志,2013,29(6):472-476.
11 Douglas CD, Low NC, Seitz MJ. The keystone flap:not an advance,just a stretch. Ann Surg Oncol, 2013, 20(3):973-980.
12张世民,宋达疆.穿支皮瓣的发现发展历史与临床启示.中国修复重建外科杂志,2017, 31(7):769-772.
13 Moncrieff MD, Thompson JF, Stretch JR. Extended experience and modifications in the design and concepts of the keystone design island flap. J Plast Reconstr Aesthet Surg, 2010, 63(8):1359-1363.
14 Monarca C, Rizzo MI, Sanese G. Keystone flap:freestyle technique to enhance the mobility of the flap. ANZ J Surg, 2012, 82(12):950-951.
15 Rao K, Raine C. Re:keystone design flap:a tension-reducing modification. ANZ J Surg, 2010, 80(7-8):574.
16曾进强,李龙,周华乔,等.负压封闭引流技术与传统换药术在软组织损伤修复中的临床疗效及安全性对比研究.临床医学工程,2016, 23(2):189-190.
17 Borgquist O, Ingemansson R, Malmsjo M. Wound edge microvascular blood flow during negative-pressure wound therapy:examining the effects of pressures from-10 to-175 mmHg. Plast Reconstr Surg, 2010,125(2):502-509.
18黎晓华,王惠东,张长青,等.封闭式负压引流技术联合皮瓣修复下肢皮肤软组织缺损.中国修复重建外科杂志,2010, 24(6):722-725.
19 Wu M, Sun M, Dai H, et al. Negative-pressure wound therapy:An effective adjunctive treatment to assist flap survival and wound closure. J Plast Reconstr Aesthet Surg, 2018, 71(11):1664-1678.
2蒋丽雅,刘元波,臧梦青,等.以旋股外侧动脉斜支为蒂的逆行股前外侧皮瓣临床应用研究.中国修复重建外科杂志,2017, 31(5):559-563.
3朱跃良,殷作明,王家祥,等.股前外侧穿支皮瓣切取技巧分析.中国修复重建外科杂志,2017, 31(1):57-61.
4 Behan FC. The keystone design perforator island flap in reconstructive surgery. ANZ J Surg, 2003, 73(3):112-120.
5邹平志,刘斌,姜任武,等.改良拱顶石皮瓣在头皮软组织缺损修复中的应用.中国美容整形外科杂志,2017, 28(10):602-603.
6 Park HS, Morrison E, Lo C, et al. An application of keystone perforator island flap for closure of lumbosacral myelomeningocele defects. Ann Plast Surg, 2015, 77(3):332-336.
7沈顺,杨超,邢新,等.改良拱顶石穿支岛状皮瓣在肛周缺损修复中的应用.中国美容整形外科杂志,2016, 27(9):532-535.
8刘伟峰,刘斌,姜任武,等.拱顶石皮瓣在足部皮肤软组织缺损修复中的应用.中国美容整形外科杂志,2016, 27(10):622-623.
9杨超,邢新,徐建国,等.拱顶石穿支岛状皮瓣在皮肤软组织缺损修复中的应用.中华整形外科杂志,2014, 30(1):10-13.
10方硕,杨超,邢新.拱顶石穿支岛状皮瓣.中华整形外科杂志,2013,29(6):472-476.
11 Douglas CD, Low NC, Seitz MJ. The keystone flap:not an advance,just a stretch. Ann Surg Oncol, 2013, 20(3):973-980.
12张世民,宋达疆.穿支皮瓣的发现发展历史与临床启示.中国修复重建外科杂志,2017, 31(7):769-772.
13 Moncrieff MD, Thompson JF, Stretch JR. Extended experience and modifications in the design and concepts of the keystone design island flap. J Plast Reconstr Aesthet Surg, 2010, 63(8):1359-1363.
14 Monarca C, Rizzo MI, Sanese G. Keystone flap:freestyle technique to enhance the mobility of the flap. ANZ J Surg, 2012, 82(12):950-951.
15 Rao K, Raine C. Re:keystone design flap:a tension-reducing modification. ANZ J Surg, 2010, 80(7-8):574.
16曾进强,李龙,周华乔,等.负压封闭引流技术与传统换药术在软组织损伤修复中的临床疗效及安全性对比研究.临床医学工程,2016, 23(2):189-190.
17 Borgquist O, Ingemansson R, Malmsjo M. Wound edge microvascular blood flow during negative-pressure wound therapy:examining the effects of pressures from-10 to-175 mmHg. Plast Reconstr Surg, 2010,125(2):502-509.
18黎晓华,王惠东,张长青,等.封闭式负压引流技术联合皮瓣修复下肢皮肤软组织缺损.中国修复重建外科杂志,2010, 24(6):722-725.
19 Wu M, Sun M, Dai H, et al. Negative-pressure wound therapy:An effective adjunctive treatment to assist flap survival and wound closure. J Plast Reconstr Aesthet Surg, 2018, 71(11):1664-1678.