游离 SCIP 皮瓣覆盖内踝缺损后,螺旋桨皮瓣辅助受区闭合:病例报告。

IF 1.5 3区 医学 Q3 SURGERY
Microsurgery Pub Date : 2024-07-19 DOI:10.1002/micr.31215
Matteo Meroni MD, Mario F. Scaglioni MD
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引用次数: 0

摘要

下肢远端缺损在整形重建领域很常见。脚踝部位皮下组织较少,经常受到高能量创伤和骨折的影响。该区域的伤口经常伴有严重水肿,可能会妨碍伤口的初次闭合。由于内侧和外侧踝关节周围的皮肤较薄且张力较大,很容易发生坏死,进而导致大面积软组织缺损。血管、神经和肌腱很容易外露。重建方法应旨在提供高质量的组织,这些组织应足够耐用,能够承受负重压力和鞋子的摩擦,同时保持足够的弹性,以符合踝关节的形状并允许足部活动。在本研究中,我们介绍了使用额外的螺旋桨皮瓣来减少受术部位皮肤张力的方法。我们使用了髂浅周动脉穿孔器(SCIP)皮瓣来覆盖内侧踝骨下方的缺损。然而,皮瓣嵌入后,无法在无张力的情况下实现近端伤口的初次闭合。在解剖胫后动脉时,确定并保留了穿孔血管。然后用其中较大的血管为螺旋桨皮瓣充血,再将其向缺损处旋转,以帮助实现无张力闭合。术后恢复顺利。这个病例为我们提供了一个宝贵的视角,让我们了解到即使在皮瓣嵌入后,伤口闭合过程中也会经常面临的挑战。由于皮瓣本身可能会增加剥离区域的宽度,因此本病例显示了在近端剥离时保留穿孔血管的重要性,因为这些血管可以用来采集额外的皮瓣以实现初次闭合并进一步减轻张力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Propeller flap's assisted recipient site closure after free SCIP flap coverage of medial ankle defect: A case report

Defects in the distal lower limbs are common in the field of orthoplastic reconstruction. The ankle area presents little subcutaneous tissue and is often affected by high-energy traumas and bone fractures. Wounds in this region are frequently associated with severe edema that might prevent primary closure. Due to its thinness and tension, the skin overlying both the medial and lateral malleoli is prone to necrosis, which can further lead to large soft tissue defects. Vessels, nerves, and tendons can easily become exposed. The reconstructive approach should aim to provide high-quality tissue that is durable enough to withstand the weight-bearing pressures and the friction from shoes, while remaining sufficiently elastic to conform to the shape of the ankle and to permit the foot movement. In this study, we describe the use of an additional propeller flap to reduce skin tension at the recipient site. A superficial circumflex iliac artery perforator (SCIP) flap was utilized to cover a defect below the medial malleolus. However, after flap inset, achieving a primary closure of the proximal wound without tension was not possible. During the dissection of the posterior tibial artery, perforator vessels were identified and preserved. The larger of these vessels was then used to vascularize a propeller flap, which was then rotated toward the defect to aid a tension-free closure. The postoperative course was uneventful. This case may provide a valuable insight into the challenges often faced during wound closure, even after flap inset. Since the flap itself may increase the width of the dissection area, the present case shows the importance of preserving perforator vessels during the proximal dissection since they can allow the harvest of an additional flap to achieve primary closure and further alleviate tension.

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来源期刊
Microsurgery
Microsurgery 医学-外科
CiteScore
3.80
自引率
19.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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