上臂外侧皮瓣和股前外侧皮瓣游离移植修复手背软组织缺损的比较研究

发布时间：2018-09-04 16:38

【摘要】：目的:通过对比上臂外侧皮瓣和股前外侧皮瓣游离移植修复手背部软组织缺损手术后的疗效指标结果,明确两种皮瓣的相对优势,为临床显微修复术式及适应症的精准选择提供决策依据。方法:选取2013年9月至2016年3月于我科行上臂外侧皮瓣或股前外侧皮瓣游离移植修复手背软组织缺损的57例患者,其中男性44例、女性13例。上臂外侧皮瓣(LUAF)组26例,股前外侧皮瓣(ALTF)组31例;如果皮瓣供区和受区的感觉神经符合重建要求,我们均进行一期重建皮瓣感觉,LUAF组重建感觉的有14例,ALTF组重建感觉的有17例。两组患者的随访时间为7-24个月不等,至2017年1月份截止,两组患者平均随访时间分别为13.6个月和14.3个月。临床资料比较的内容包括:患者的一般信息,术后手功能,皮瓣切取面积,重建感觉皮瓣的感觉恢复优良率,皮瓣修形手术率,供区和受区总体并发症发生率以及重要并发症的发生率(受区重要并发症包括血管危象、血肿形成、伤口裂开、皮瓣感染、部分坏死、延迟愈合;供区重要并发症包括感觉异常、短期麻木、色素沉着、瘢痕增生、短期关节受限),供区与受区满意度得分(1-6分,1分最差,6分最好)。结果:通过比较发现,两组患者一般信息无明显差异。LUAF组的皮瓣成活率为92.31%,ALTF组为93.55%,差异不显著。参照中华医学会手外科学分会上肢部分功能标准评定手功能:LUAF组优5例、良6例、可11例,差4例;ALTF组优5例、良5例、可14例、差7例;两组手功能无统计学差异。切取的皮瓣面积,LUAF组平均为80±18cm2,ALTF组的平均面积是143±44cm2,差异显著。LUAF组的皮瓣修形手术率为30.77%,ALTF组为48.39%,差异显著。重建感觉的LUAF和ALTF术后感觉恢复的效果理想,按优良率比较,LUAF组的优良率为78.57%,ALTF组为64.71%,差异不显著。LUAF组和A LTF组受区总体并发症发生率分别为23.08%和32.36%,差异不显著。受区重要并发症发生率方面,血管危象分别为7.69%和6.45%,血肿形成分别为11.53%和16.13%,伤口裂开分别为7.69%和12.90%,皮瓣感染分别为3.85%和6.45%,部分坏死分别为15.38%和25.58%,延迟愈合分别为7.69%和29.03%,其中只有延迟愈合率差异显著,其他受区并发症发生率无显著差异。LUAF组和ALTF组供区总体并发症发生率分别为65.38%和54.83%,差异不显著。供区重要并发症发生率方面,感觉异常分别为15.38%和6.45%,短期麻木分别为38.46%和22.58%,色素沉着分别为19.23%和32.26%,瘢痕增生分别为7.69%和16.13%,短期关节受限分别为34.61%和22.58%,差异不显著。供区所有重要并发症发生率差异均不显著。LUAF组受区和供区满意度平均得分分别为3.77和4.35,差异显著,ALTF组受区和供区满意度平均得分分别为3.19和4.03,差异不显著。结论:上臂外侧皮瓣和股前外侧皮瓣游离移植修复手背软组织缺损,两种方法均可靠,皮瓣成活率高,供受区总体并发症率无显著差异。股前外侧皮瓣切取的皮瓣平均面积大于上臂外侧皮瓣。重建感觉的两组皮瓣术后感觉恢复效果理想,差异无统计学意义。上臂外侧皮瓣游离移植修复手背软组织缺损的受区满意度优于股前外侧皮瓣组,而供区满意度差异不显著。
[Abstract]:Objective:To determine the comparative advantages of the two kinds of flaps by comparing the outcomes of the upper arm lateral flap and the anterolateral thigh flap in repairing the soft tissue defect of the hand dorsum. The lateral or anterolateral thigh flaps were transplanted freely to repair the soft tissue defect of the dorsum of hand in 57 patients, including 44 males and 13 females. The lateral arm flap (LUAF) group consisted of 26 cases and the anterolateral thigh flap (ALTF) group consisted of 31 cases. The follow-up time ranged from 7 to 24 months. The average follow-up time between the two groups was 13.6 months and 14.3 months, respectively. Rehabilitation rate, flap repair rate, overall complication rate in donor and recipient areas, and incidence of major complications (important complications in recipient areas include vascular crisis, hematoma formation, wound rupture, flap infection, partial necrosis, delayed healing; important complications in donor areas include abnormal sensation, short-term numbness, pigmentation, scar hyperplasia, and short-term healing) Results: There was no significant difference in general information between the two groups. The survival rate of flaps in LUAF group was 92.31%, and that in ALTF group was 93.55%. The difference was not significant. There were 5 excellent cases, 6 good cases, 11 fair cases and 4 poor cases in ALTF group, 5 good cases, 14 fair cases and 7 poor cases in ALTF group. There was no significant difference in hand function between the two groups. The overall incidence of complications was 23.08% in LUAF group and 32.36% in ALTF group, respectively. The incidence of major complications in recipient area was 7.69% and 6.45% in vascular crisis and hematoma formation respectively. 11.53% and 16.13%, wound dehiscence 7.69% and 12.90%, flap infection 3.85% and 6.45%, partial necrosis 15.38% and 25.58%, delayed union 7.69% and 29.03% respectively. Only the difference of delayed union rate was significant, and the incidence of complications in other recipient areas was not significant. The overall complication rates of donor areas in LUAF group and ALTF group were 3.85% and 6.45% respectively. The incidence of important complications in donor sites was 15.38% and 6.45%, short-term numbness 38.46% and 22.58%, pigmentation 19.23% and 32.26%, scar hyperplasia 7.69% and 16.13%, short-term joint limitation 34.61% and 22.58%, respectively. There was no significant difference in the incidence of complications. The average scores of recipient and donor satisfaction in LUAF group were 3.77 and 4.35, respectively. The average scores of recipient and donor satisfaction in ALTF group were 3.19 and 4.03, respectively. The average area of the anterolateral thigh flaps was larger than that of the lateral upper arm flaps. The anterolateral flap group had no significant difference in donor site satisfaction.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R658.2

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