摘要目的 探讨带蒂腹壁下动脉穿支皮瓣的分型,以及手术适应证和技术要点.方法2005年7月至2017年12月,应用带蒂腹壁下动脉穿支皮瓣修复18例患者软组织缺损,缺损位置包括腹部6例,髂腰部2例,会阴部4例,大腿近端6例.皮瓣分成2种类型,Ⅰ型为螺旋桨皮瓣,其中又分成2种亚型,以腹壁下动脉穿支为蒂的为Ⅰa型;以腹壁下动脉穿支为蒂、但切断血管主干为Ⅰb型.Ⅱ型是传统的以腹壁下动脉穿支为蒂的岛状皮瓣.结果18例患者(20块皮瓣)中,包括Ⅰa型皮瓣4块,皮瓣大小平均为19.0 cm×6.5 cm;血管蒂长度平均2.88 cm;旋转角度分别为60°1例、120°1例和180°2例.Ⅱb型皮瓣3块,皮瓣大小分别为26 cm×6 cm、20 cm×5 cm和24 cm×7 cm;血管蒂长度分别为6 cm、7 cm和7 cm;皮瓣旋转角度均为180°.Ⅱ型皮瓣13块,皮瓣大小平均为21.5 cm×9.4 cm,血管蒂长度平均11.08 cm.手术后17块皮瓣全部成活,Ⅰa、Ⅰb和Ⅱ型皮瓣各有1例出现皮瓣尖端小面积坏死,2例经换药处理后,创面直接缝合,1例创面清创后,植皮修复.18例患者获随访,随访6个月至5年,平均11个月;所有患者对治疗效果满意,肿瘤患者随访期间未见肿瘤复发.结论带蒂腹壁下动脉穿支皮瓣既可以岛状皮瓣形式用于腹部、腰部、大腿近端及会阴部的缺损修复,亦可作为螺旋桨皮瓣修复腹部、髂腰部缺损,是兼具灵活性及可靠性的有效修复方法.

abstractsObjective To propose a classification method and explore the indications and technical tips of the pedicled deep inferior epigastric artery perforator ( DIEAP) flap. Methods From July 2005 to December 2017, 18 patients underwent soft-tissue defect repairment using the pedicled DIEAP flap. The defect locations included abdomen (n=6), iliolumbar region (n=2), perineum (n=4), and proximal thigh (n=6). The flaps were divided into two types. The type Ⅰ flap were further subdivided into two subtypes. The type Ⅰa flap was solely based on the DIEAP. The type Ⅰb flap was also based on the DIEAP, however, the main trunk of the deep inferior epigastric vessels needs to be divided to further improve the pedicle length. The type Ⅱ flap was the traditional pedicled DIEAP flap. Results Twenty flaps were included in this series. The mean flap size and pedicle length of the 4 flaps in type Ⅰa were 19. 0 cm × 6. 5 cm and 2. 88 cm respectively. The rotation angles were 60 degrees (n=1), 120 degrees (n=1), and 180 degrees (n=2). The 3 flaps of typeⅠb was 26 cm × 6 cm, 20 cm × 5 cm and 24 cm × 7 cm in size, and the pedicle lengths of them were 6 cm, 7 cm and 7 cm, respectively. All flaps in this subtype were rotated by 180 degrees. The mean flap size and pedicle length of the 13 type Ⅱ flaps were 21. 46 cm × 9. 38 cm and 11. 08 cm. 17 flaps completely survived postoperatively. Small-sized necrosis of the distal portion of the flap occurred in 3 flaps. All patients were followed up for 6 months to 5 years, with the averaged 11 months follow-up time. All patients were satisfied with the final outcomes. Tumor recurrence was not noticed for the oncological patients. Conclusions The pedicled DIEAP flap has remarkable versatility in the defect repairment for the regions including abdomen, iliolumbar region, proximal thigh, and perineal region. Combining with the"propeller flap" concept, the clinical application of pedicled DIEAP flap could be further expanded. The pedicled DIEAP flap is a reliable reconstructive method for defect repairment in abdominal and iliolumbar regions.