摘要目的 探讨穿支皮瓣修复躯干部肿瘤切除后大面积缺损时Choke血管区保护的临床意义.方法 2012年3月至2016年1月,苏州大学附属第二医院整形外科修复躯干部大面积缺损患者62例,男38例,女24例;年龄19～79岁.依据术前多普勒探测的穿支位置,设计穿支皮瓣,以穿支为蒂,深筋膜层深面(包含部分肌膜),切取皮瓣5.0 cm×10.0 cm至22.0 cm×19.0 cm,供区直接拉拢缝合或局部皮瓣移位修复.结果 62例中59例皮瓣成活良好;1例糖尿病患者术后皮瓣尖端部分坏死,换药后愈合;1例阴囊缺损患者术后皮瓣远端表皮坏死,换药后愈合;1例褥疮患者术后10 d,皮瓣坏死,2次修复.17例随访3个月至2年,25例随访6个月至2年,后期效果均良好.隆突性纤维肉瘤和鳞状细胞癌各1例复发,一期修复后功能及外形均满意.结论 对Choke血管区的保护可提高穿支皮瓣血供,获得较大的皮瓣成活面积及成活质量.

abstractsObjective To explore the clinical significance of protection "Choke vessel area" in the application of perforator flap to repair large defect of trunk after tumor resection.Methods A total of 62 patients (38 males and 24 females,aged from 19 to 79 years) from the Department of Plastic Surgery,Second Affiliated Hospital of Suzhou University underwent reconstructive surgery for large area defects of the trunk from March 2012 to January 2016.The perforator flap was designed according to the perforator location detected by Doppler before surgery.The flaps were harvested on the pedicle of perforators and dissected on the deep layer of deep fascia (including part of the myolemma).The areas of flap ranged from 5.0 cm × 10.0 cm to 19.0 cm × 22.0 cm.The donor site was sutured directly or local flap was transferred to repair.Results Flaps survived well in 59 of the 62 cases.The tip of flap was necrotic and healed after dressing change in 1 diabetic patient.The distal part of flap was necrotic on cuticular layer and healed after dressing change in another patient with scrotal defect.One patient had flap necrosis 10 days after operation and was repaired twice.The results were satisfied after following-up from 3 months to 2 years for 17 cases and from 6 months to 2 years for 25 cases.Fibrosarcoma protuberant and squamous cell carcinoma recurred in 1 case each,but the function and appearance were satisfactory after primary repair.Conclusions The procedure of preserving Choke vessel area can improve the blood supply of perforator flap and obtain larger survival area and survival quality.It is worthy of clinical application.