摘要目的:探讨超薄腹股沟皮瓣游离移植修复手足创面的效果。方法:该研究为病例系列研究。2021年1月—2024年3月，武汉大学同仁医院暨武汉市第三医院收治18例符合入选标准的手足部皮肤软组织缺损伴肌腱和/或骨损伤、外露的患者（男14例、女4例，年龄19~66岁），共21个创面，其中12个位于手部、9个位于足部。清创后皮肤软组织缺损面积为5.0 cm×2.5 cm~16.0 cm×5.0 cm。以纯皮穿支为中心，应用逆行解剖法获取含真皮下血管网的超薄腹股沟皮瓣，皮瓣大小为6.0 cm×3.0 cm~17.0 cm×6.5 cm。其中，15个皮瓣以旋髂浅动脉为血管蒂，5个皮瓣以旋髂浅动脉和腹壁浅动脉共干为血管蒂，1个皮瓣以旋髂浅动脉和腹壁浅动脉双血管为血管蒂。将皮瓣转移至受区创面，将血管蒂中的动静脉与受区动静脉端端吻合，然后封闭创面。减张缝合供区创面。术中，测量并记录皮瓣厚度、血管蒂中动脉吻合口径、携带的纯皮穿支数及多穿支皮瓣中相邻纯皮穿支间距离。术后，观察皮瓣成活情况、并发症发生情况及供区创面愈合情况。随访时，观察受区修复情况。末次随访时，根据总主动活动度（TAM）评估患指功能，采用美国足踝外科医师协会踝-后足评分系统（AOFAS-AHS）对患足功能进行评分，采用利克特量表评价患者对疗效的满意度。结果:患者皮瓣厚度为0.2~0.5 cm，平均0.4 cm；血管蒂中动脉吻合口径为0.5~1.2 mm，平均0.7 mm；7个皮瓣各携带1条纯皮穿支，6个皮瓣各携带2条纯皮穿支，8个皮瓣各携带3条纯皮穿支；多穿支皮瓣中相邻纯皮穿支间距离为0.8~3.5 cm，平均1.7 cm。术后，1个皮瓣出现小范围坏死，经清创缝合后成活；其余皮瓣均顺利成活。3个患指远端存在血运障碍，行动脉再通后均成活。1个供区创面因局部张力较高愈合不良，经清创缝合后愈合；其余供区创面均顺利愈合。术后6~35个月随访时，皮瓣质地柔软、弹性良好，其中2个皮瓣因局部稍显臃肿，于术后3~5个月行修薄处理。末次随访时，10个患指的TAM评估为优、2个为良，9个患足的AOFAS-AHS评分为99~100分，18例患者对疗效均表示非常满意。结论:超薄腹股沟皮瓣具有厚度薄、血运丰富、切取方法可靠等优点，用于修复手足烧创伤后创面，可获得理想的外形与功能效果，且术后二次修整率低，值得临床推广应用。

abstractsObjective:To explore the effects of ultrathin inguinal flap free transplantation in repairing hand and foot wounds.Methods:This study was a case series study. From January 2021 to March 2024, 18 patients (14 males and 4 females, aged 19 to 66 years) with skin and soft tissue defects of hands and feet accompanied by tendon and/or bone injuries and exposure were admitted to Tongren Hospital of Wuhan University & Wuhan Third Hospital. A total of 21 wounds were involved, including 12 on hands and 9 on feet. The area of skin and soft tissue defects after debridement was 5.0 cm×2.5 cm to 16.0 cm×5.0 cm. Using the reverse dissection method, ultrathin inguinal flaps containing the subdermal vascular network were obtained with the pure skin perforator as the center. The size of flaps was 6.0 cm×3.0 cm to 17.0 cm×6.5 cm. Among them, 15 flaps were based on the superficial circumflex iliac artery as the vascular pedicle, 5 flaps were based on the common trunk of the superficial circumflex iliac artery and the superficial epigastric artery as the vascular pedicle, and 1 flap was based on the dual vessels of the superficial circumflex iliac artery and the superficial epigastric artery as the vascular pedicle. The flaps were transferred to the recipient wounds, and the arteries and veins of the vascular pedicles were end-to-end anastomosed with the recipient arteries and veins, and then the wounds were closed. The donor site wounds were sutured with tension reduction. During the operation, the thickness of flaps, the diameter of arterial anastomosis in vascular pedicle, the number of pure skin perforators carried, and the distance between adjacent pure skin perforators in multi-perforator flaps were measured and recorded. Postoperatively, the survival of the flaps, the occurrence of complications, as well as the healing of the donor site wounds were observed. During follow-up, the repair of the recipient areas was observed. At the last follow-up, the total active motion (TAM) was used to evaluate the function of the affected fingers, and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) was used to score the function of the affected feet. The Likert scale was used to evaluate the patients' satisfaction with the therapeutic effect.Results:The thickness of flaps of patients was 0.2 to 0.5 cm, with an average of 0.4 cm; the diameter of arterial anastomosis in vascular pedicle was 0.5 to 1.2 mm, with an average of 0.7 mm; 7 flaps each carried one pure skin perforator, 6 flaps each carried two pure skin perforators, and 8 flaps each carried three pure skin perforators. The distance between adjacent pure skin perforators in multi-perforator flaps was 0.8 to 3.5 cm, with an average of 1.7 cm. Postoperatively, one flap showed small area of necrosis, which survived after debridement and suture; the remaining flaps survived smoothly. Three affected fingers had blood supply disorder at the distal end, and all survived after arterial recanalization. One donor site wound healed poorly due to high local tension and healed after debridement and suture, and the remaining donor site wounds healed smoothly. During the 6 to 35 months of follow-up, the flaps were soft and elastic. Two flaps were slightly swollen and underwent thinning treatment 3 to 5 months after surgery. At the last follow-up, the TAM of 10 affected fingers were excellent, and two were good, the AOFAS-AHS score of 9 affected feet was 99 to 100 points, and all 18 patients were very satisfied with the effects.Conclusions:The ultrathin inguinal flap has the advantages of thin thickness, rich blood supply, and reliable harvesting method. Its application in repairing hand and foot wounds after burns and trauma can achieve ideal aesthetic and functional results, with a low rate of secondary revision, and it is worthy of clinical promotion and application.