中国修复重建外科杂志

中国修复重建外科杂志

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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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、肤色与周围皮肤一致,关节功能不受限,是一种安全、有效的治疗方法。

ObjectiveTo explore the efficacy of keystone flap in repairing skin and soft tissue defects around joint.MethodsBetween 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 in 3 cases, basal cell carcinoma in 3 cases, squamous-cell carcinoma in 3 cases, and dermatofibrosarcoma protuberant in 1 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.ResultsPrimary 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.ConclusionThe 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.

关键词: 拱顶石皮瓣; 改良皮瓣; 关节; 创面修复

Key words: Keystone flap; modified flap; joint; wound repair

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