[彩色多普勒超声辅助下的超薄胸背动脉穿孔器皮瓣切割方案及临床应用效果]。

S M Zhao, N Liu, X L Liu, S L Ji
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引用次数: 0

摘要

目的探讨彩色多普勒超声辅助下超薄胸背动脉穿孔皮瓣的切割方案及临床应用效果。方法:本研究为回顾性历史对照研究:本研究为回顾性历史对照研究。2017年2月-2019年10月,选取华北医疗卫生集团邢台总医院骨三科(以下简称我科)收治的符合纳入标准,根据外科医生临床经验设计并采集胸背动脉超薄打孔器皮瓣修复四肢皮肤软组织缺损的患者20例作为对照组,其中男16例,女4例,年龄(37±5)岁。2019年11月-2022年12月,选取我科收治的符合纳入标准,并在彩色多普勒超声辅助下设计并采集超薄胸背动脉穿孔器皮瓣进行四肢皮肤软组织缺损修复的21例患者作为超声辅助组,其中男15例,女6例,年龄(38±6)岁。清创后,四肢皮肤和软组织缺损面积为 5.0 cm×4.0 cm 至 19.0 cm×8.0 cm,胸背动脉穿孔皮瓣面积为 6.0 cm×5.0 cm 至 20.0 cm×9.0 cm。皮瓣供区的伤口直接缝合。对于超声辅助组患者,记录彩色多普勒超声检查所需的时间和费用,并将术前彩色多普勒超声检测到的胸背动脉穿孔血管数量、类型和位置与术中实际检测到的胸背动脉穿孔血管数量、类型和位置进行比较。记录两组患者完全切除皮瓣所需的时间。在术后第 1、3、5、7 和 14 天,使用皮瓣灌注评估量表评估两组患者皮瓣的血液灌注情况。在 POD 14,观察两组患者的皮瓣存活率,并计算皮瓣存活面积的百分比。术后 6 个月,使用 5 级李克特量表评估两组患者对治疗结果的满意度,并计算满意率。结果超声辅助组患者术前彩色多普勒超声检查所需时间为(10.5±2.3)min,费用为120元;术前彩色多普勒超声检测并标记胸背动脉穿孔血管21条,其中1型穿孔血管8条(38.10%),2型穿孔血管10条(47.62%),3型穿孔血管3条(14.29%);术前检测到的胸背动脉穿孔血管数量、类型、位置与术中检测到的一致。超声辅助组患者完全切除皮瓣所需的时间为(41±10)分钟,明显短于对照组的(63±12)分钟(t=6.32,Pt 值分别为 6.67、7.48、8.03、8.75 和 7.99,Pt=4.57,PP>0.05)。结论术前彩色多普勒超声能高度准确地检测穿孔血管的数量、类型和位置。可根据不同类型的穿孔血管设计超薄胸背动脉穿孔皮瓣的切割方案,缩短皮瓣切割时间,提高皮瓣成活率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Cutting scheme and clinical application effects of ultrathin thoracodorsal artery perforator flap assisted by color Doppler ultrasound].

Objective: To explore the cutting scheme and clinical application effects of ultrathin thoracodorsal artery perforator flap assisted by color Doppler ultrasound. Methods: This study was a retrospective historical control study. From February 2017 to October 2019, 20 patients who were admitted to the Third Department of Orthopedics of Xingtai General Hospital of North China Medical and Health Group (hereinafter referred to as our department), met the inclusion criteria, and underwent repair of skin and soft tissue defects of extremities with ultrathin thoracodorsal artery perforator flap designed and harvested based on the surgeon's clinical experience were selected as control group, including 16 males and 4 females, aged (37±5) years. From November 2019 to December 2022, 21 patients who were admitted to our department, met the inclusion criteria, and underwent repair of skin and soft tissue defects of extremities with ultrathin thoracodorsal artery perforator flap designed and harvested under the assistance of color Doppler ultrasound were selected as ultrasound-assisted group, including 15 males and 6 females, aged (38±6) years. After debridement, the area of skin and soft tissue defects of extremities ranged 5.0 cm×4.0 cm to 19.0 cm×8.0 cm, and the area of thoracodorsal artery perforator flaps ranged 6.0 cm×5.0 cm to 20.0 cm×9.0 cm. The wounds in flap donor sites were closed directly. For patients in ultrasound-assisted group, the time and cost required for color Doppler ultrasound examination were recorded, and the number, type, and location of thoracodorsal artery perforator vessels detected by preoperative color Doppler ultrasound were compared with those of intraoperative actual detection. The time required for complete flap harvest of patients in 2 groups was recorded. On postoperative day (POD) 1, 3, 5, 7, and 14, the blood perfusion of flaps in the 2 groups of patients was assessed using a flap perfusion assessment scale. On POD 14, flap survival of patients in 2 groups was observed, and the percentage of flap survival area was calculated. In postoperative 6 months, satisfaction of patients with the treatment outcome in the 2 groups was assessed using 5-grade Likert scale, and the satisfaction rate was calculated. Results: For patients in ultrasound-assisted group, the time required for preoperative color Doppler ultrasound examination was (10.5±2.3) min, and the cost was 120 yuan; 21 thoracodorsal artery perforator vessels were detected and marked using preoperative color Doppler ultrasound, including 8 (38.10%) type 1 perforator vessels, 10 (47.62%) type 2 perforator vessels, and 3 (14.29%) type 3 perforator vessels; the number, type, and location of thoracodorsal artery perforator vessels detected preoperatively were consistent with those detected intraoperatively. The time required for complete flap harvest of patients in ultrasound-assisted group was (41±10) min, which was significantly shorter than (63±12) min in control group (t=6.32, P<0.05). On POD 1, 3, 5, 7, and 14, the blood perfusion scores of flaps of patients in ultrasound-assisted group were significantly better than those in control group (with t values of 6.67, 7.48, 8.03, 8.75, and 7.99, respectively P<0.05). On POD 14, only one patient in ultrasound-assisted group had partial flap necrosis and 6 patients in control group had complete or partial necrosis of the flap; the percentage of flap survival area of patients in ultrasound-assisted group was (99±8)%, which was significantly higher than (87±8)% in control group (t=4.57, P<0.05). In postoperative 6 months, there was no significant difference in the satisfaction rate of patients with the treatment outcome between the two groups (P>0.05). Conclusions: Preoperative color Doppler ultrasound is highly accurate in detecting the number, type, and location of perforator vessels. The cutting scheme of ultrathin thoracodorsal artery perforator flaps can be designed according to the different types of perforator vessels, with shorted flap cutting time and improved flap survival rate.

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