腓肠内侧动脉穿支皮瓣和前臂皮瓣的术后供区影响对比

doi:10.12016/j.issn.2096-1456.2018.08.007

摘要/Abstract

摘要：

目的对比口腔颌面部组织缺损患者应用腓肠内侧动脉穿支皮瓣与前臂皮瓣修复术后供区并发症,探讨腓肠内侧动脉穿支皮瓣的临床应用价值和优势。方法选择2010年4月—2011年4月,因口腔颌面部肿瘤在北京大学口腔医院住院治疗的患者,20例肿瘤切除后组织缺损应用腓肠内侧动脉穿支皮瓣修复,同期另有20例行前臂皮瓣修复,比较术后供区并发症发生情况,包括术后2周内的近期并发症和3个月以上的远期并发症。近期并发症包括植皮下积液、植皮部分坏死、伤口裂开、伤口感染、供区组织坏死及功能障碍等。远期并发症包括瘢痕、色素沉着、感觉异常及功能障碍等,同时采用患者主观评价和供区客观检查对供区的远期功能恢复进行评价。结果在20例采用腓肠内侧动脉穿支皮瓣修复口腔颌面部组织缺损的病例中,1例供区植皮,其余19例均为直接拉拢缝合,术后1例出现供区肌肉坏死,术后供区只有线形瘢痕,对外形和功能影响轻微。在20例前臂皮瓣中,供区创面全部植皮,近期供区并发症为植皮下积液3例,植皮部分坏死2例,伤口裂开2例。术后远期供区主观感受比较显示,前臂组感觉异常有16例,腓肠内侧动脉穿支皮瓣组感觉异常有5例,差异有统计学意义（P < 0.05）,其余主观感受比较无统计学意义（P > 0.05）。前臂皮瓣组与腓肠内侧动脉穿支皮瓣组相比出现明显瘢痕增生和色素沉着（P < 0.05）,但功能客观检查差异都无统计学意义（P > 0.05）。结论对于口腔颌面部中小型缺损,应用腓肠内侧动脉穿支皮瓣修复,供区并发症少,远期对供区外观影响小,修复效果好,可以部分替代前臂皮瓣。

关键词: 腓肠内侧动脉穿支皮瓣, 前臂皮瓣, 供区并发症, 显微外科, 重建

Abstract:

Objective To demonstrate the advantages of performing medial sural artery perforator flap compared with forearm flap. Methods Between April 2010 and April 2011, 20 clinical cases were reconstructed using the medial sural artery perforator flap technique and compared with 20 forearm flap cases. Data on recent complications (in 2 weeks) and late complications (after 3 months) were collected. Results Of the 20 medial sural artery perforator flaps, Only 1 case needed a skin graft, while 19 cases were primarily closed, and 1 case occurred muscle necrosis. Only linear scar was found in the postoperative donor area, and the effect on appearance and function was slight. Of the 20 forearm flaps, all cases needed a skin graft. For the recent complications, 3 cases of effusion under the skin graft, 2 cases of partial necrosis and 2 cases of wound dehiscence were observed. For the late complications of the forearm, 16 cases of an abnormal sensation were observed in the forearm group and 5 cases of an abnormal sensation were observed in the medial sural artery perforator flap group, and these differences were statistically significant (P <0.05). Significant differences were not observed in the other subjective contrasts(P >0.05). Scarring and pigmentation were much more serious in the forearm cases than the medial sural artery cases (P <0.05), and significant differences in the functional objective examination results were not observed between the two groups (P >0.05). Conclusion The medial sural artery perforator flap represents a good alternative for oral and maxillofacial reconstructions of small- and medium-sized defects, and it presents advantages over the forearm flap since it has less donor-site morbidity.

Key words: Medial sural artery perforator flap, Forearm flap, Donor site complication, Microsurgery, Reconstruction

中图分类号:

崔秋菊, 毛驰, 栾修文, 王洋, 张雷. 腓肠内侧动脉穿支皮瓣和前臂皮瓣的术后供区影响对比[J]. 口腔疾病防治, 2018, 26(8): 514-518.

Qiuju CUI, Chi MAO, Xiuwen LUAN, Yang WANG, Lei ZHANG. Comparative study of donor site complications between the medial sural artery perforator flap[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2018, 26(8): 514-518.

图/表 5

图1 两组皮瓣术后近期并发症 a: 腓肠内侧动脉穿支皮瓣供区坏死表现;b：前臂皮瓣植皮下积液表现;c：前臂皮瓣植皮部分坏死 ;d：前臂皮瓣伤口裂开。

Figure 1 Recent postoperative complications observed in both groups

表1 供区功能主观对比情况

Table 1 Subjective contrast of the donor site n（%）

组别	例数	肌力减退	关节活动受限	感觉异常	供区外观
腓肠内侧动脉穿支皮瓣组	14	2（14.29）	1（7.14）	5（35.71）	2（14.29）
前臂皮瓣组	16	7（43.75）	5（31.25）	16（100.00）	5（31.25）
χ²值		3.087	2.712	14.694	1.714
P值		> 0.05	> 0.05	< 0.05	> 0.05

表2 供区功能客观检查对比情况

Table 2 Objective contrast of the functions of the donor site n（%）

组别	例数	肌力减退	关节活动受限	感觉异常
腓肠内侧动脉穿支皮瓣组	14	0（0.00）	1（7.14）	14（100.00）
前臂皮瓣组	16	2（12.50）	2（12.50）	16（100.00）
χ²值		1.875	0.238	-
P值		> 0.05	> 0.05	-

图2 供区瘢痕图片 a：腓肠内侧动脉穿支皮瓣供区瘢痕;b：前臂皮瓣供区瘢痕。

Figure 2 Images of the donor-site scars

表3 供区外观客观检查对比情况

Table 3 Objective contrast of the appearance of the donor site n（%）

组别	例数	增生瘢痕	色素沉着
腓肠内侧动脉穿支皮瓣组	14	2（14.28）	1（7.14）
前臂皮瓣组	16	9（56.25）	16（100.00）
χ²值		5.662	26.218
P值		0.026	< 0.001

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