依创面立体定形游离皮瓣临床应用.docVIP

依创面立体定形游离皮瓣临床应用[摘要]目的：探讨应用游离皮瓣修复软组织缺损的方法及效果。方法：选择24例需要行游离皮瓣修复创面的患者，根据其软组织的不同缺损情况，取无菌棉布片制作与创面相同形状的模板，切下皮瓣后依据创面的形状及深度修剪掉皮瓣多余的脂肪组织，保留皮瓣的营养血管网，制备成立体的定形皮瓣填补创面缺损。皮瓣切取面积最小1.5cm×2.5cm，最大12cm×24cm，供区直接缝合或中厚皮片修复。结果：术后皮瓣全部成活，创面修复后表面平坦，术后随访13例，随访时间3～36个月，皮瓣颜色、质地和厚薄与受区相近，外形、功能恢复满意。皮瓣感觉恢复至S2～S4。结论：立体定形皮瓣兼顾了受区外形与功能的修复，是创面美容修复的理想方法。 [关键词]游离皮瓣；创面修复；美学；移植；显微外科 [中图分类号]R622 [文献标识码]A [文章编号]1008-6455（2013）01-0100-03 Stereo finalize the clinical application of free flap according to the wound ZHAO Feng-lin，WANG Wen-de，HAN Hui-feng，WANG Xin （Department of Plastic Surgery，The Third People Hospital of Jinan，Jinan250101，Shandong，China） Abstract： Objective To r an ideal method to repair wounds by using free flap. Methods 24 clinical cases of wounds requiring free flap to repair were selected. A template was made in terms of the shape of soft tissue defect of wound by using a sterile cotton piece. Cut and clip redundant adipose tissue of the flap on the basis of the wound appearance and the organizational level，keep the flap nutrient vessels of the flap. Then， the flap was transferred to wound defect. The minimum area of skin flap was 1.5 cm×2.5 cm as well as the biggest one 12cm×24cm. The plantar donor site was sutured directly or repaired by intermediate-thickness skin graft. Results 24 cases flaps were all survived with a flat surface，and 13 of which were followed up from 3 to 36 months，the appearance and function of these repaired wounds gained ideal outcome. The sensory of the flaps recovered to S2～S4. Conclusion This kind of flap has both the recovery of appearance and function.It is an ideal way of cosmetic restoration. Key words：free flap；wound repair；aesthetics；transplantation； microsurgery 临床上形状不规则和深浅不一的创面较多见，应用传统的皮瓣修复后常存在皮瓣臃肿、需多次修薄等缺点[1-2]。为了提升游离皮瓣修复创面的手术效果，笔者根据创面的形状及深浅程度来剪裁皮瓣，制备成与创面立体结构一致的皮瓣填补创面缺损，后期不需要再进行皮瓣整形术。临床应用24例，经随访被修复部位的外形恢复良好，取得了满意的美学效果。 1 临床资料 本组共24例，其中男19例，女5例，年龄15～58岁，平均32.3岁；创面形状均不规则，面积最小1.5cm×2.5cm，最大12.0cm×22.0cm。皮瓣的面积最小1.5cm×2.5cm，最大12.0