背景:带蒂腹部皮瓣是一种广泛用于软组织缺损患者前臂重建的外科技术。然而,一些缺点包括限制皮瓣尺寸,部分皮瓣损失,和供体部位的发病率。为了解决这些问题,我们介绍了一例使用深腹壁下动脉穿支(DIEP)进行前臂重建的带蒂腹部皮瓣,该患者具有较大的软组织缺损。
方法:我院收治一名46岁男性患者,前臂受推压机损伤。发现15cm×10cm的软组织缺损,前臂尺侧结构完全破裂。使用Masquelet技术第一阶段对神经血管损伤和骨折进行骨科治疗一周后,患者被转介到整形外科和重建外科进行伤口覆盖。手术清创和负压伤口治疗发现20cm×15cm的软组织缺损。带有DIEP的带蒂腹部皮瓣用于覆盖缺损。三周后,皮瓣从腹部脱离,腹部缺损直接闭合。随后,Masquelet技术的第二阶段在第10周时在骨折部位进行.最后,所有供体和受体部位均已愈合,无并发症,如皮瓣开裂,感染,血肿,或坏死。骨折部位接骨术无并发症。
结论:使用DIEP的腹部带蒂皮瓣为大型软组织缺损患者的前臂重建提供了可靠的选择。
BACKGROUND: Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects. However, some drawbacks include restricted flap size, partial flap loss, and donor-site morbidity. To address these concerns, we present a
case of a pedicled abdominal flap using the deep inferior epigastric artery perforators (DIEP) for forearm reconstruction in a patient with a large soft tissue defect.
METHODS: A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine. A 15 cm × 10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found. One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique, the patient was referred to the plastic and reconstructive surgery department for wound coverage. Surgical debridement and negative-pressure wound therapy revealed a 20 cm × 15 cm soft tissue defect. A pedicle abdominal flap with the DIEP was used to cover the defect. Three weeks later, the flap was detached from the abdomen, and the abdominal defect was directly closed. Subsequently, the second stage of Masquelet technique was performed at the fracture site at week 10. Finally, all donor and recipient sites healed without complications, such as flap dehiscence, infection, hematoma, or necrosis. Fracture site osteosynthesis was achieved without complications.
CONCLUSIONS: Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.