摘要目的 介绍选择供血血管的游离髂腹部穿支皮瓣的临床应用体会.方法 设计选择供血血管及穿支为蒂的髂腹部游离皮瓣移植修复四肢软组织缺损,临床应用30例,其中以旋髂浅动脉为蒂12例,以旋髂深动脉及穿支为蒂14例,以旋髂浅深动脉共干为蒂4例.皮瓣切取面积最大22.0cm×10.0cm,最小8.0cm×6.0cm.结果 术后所有皮瓣均顺利存活,供区创面直接缝合.随访时间3～6个月.修复前臂及小腿(12例)皮瓣外观满意;修复手及足踝部(18例)皮瓣较臃肿,二期行整形术.供区仅遗留线条瘢痕,未出现任何并发症.结论 髂腹部皮瓣供区隐蔽,供皮量大,是修复四肢软组织缺损的良好供区;但供血血管有旋髂浅动脉及旋髂深动脉两类,且穿支或皮支的解剖有一定变异,具体手术时应根据供血血管的口径、走行灵活选择.

abstractsObjective To introduce clinical experiences of free ilio-abdominal flap pedicled with selective perforating branches. Methods Based on successful clinical application of free iliac flaps, we designed free ilio-abdominal flaps pedicled with selective perforating branches. Thirty such flaps were transferred to repair soft tissue defects in the extremities. There were 12 ilio-abdominal flaps pedicled with the superficial iliac circumflex artery, 14 pedicled with the deep iliac circumflex artery and 4 pedicled with a common trunk of the superficial and deep iliac circumflex arteries. The area of the flaps ranged from 8.0 cm × 6.0 cm to 22.0cm×10.0 cm. Results All 30 flaps survived. The donor sites were closed directly. Postoperative follow-up ranged from 3 to 6 months. The appearances of 12 flaps used to repair forearm and lower leg sites were satisfactory, while 18 flaps used to repair hand and ankle sites needed secondary surgery to debulk. The donor site only had a linear scar, without any complications. Conclusion The ilio-abdominal flap is an ideal flap for soft tissue loss in extremities in that the donor site is discreet and the harvestable area is big. However harvesting of the flap should be adjusted during the surgery based on the diameter and course of the blood vessels because the blood supply of the ilio-abdominal flap can be based on the superficial or deep iliac circumflex arteries, and the perforating branches and cutaneous branches of the flap can vary.