[Clinical efficacy of pedicled double-perforator flap of the inferior epigastric artery in reconstructing the soft tissue defects following resection of cutaneous malignant tumors].

摘要

Objective: To investigate the clinical efficacy of pedicled double-perforator flap of the inferior epigastric artery in reconstructing the soft tissue defects following resection of cutaneous malignant tumors adjacent to major vessels and/or nerves in the groin or thigh. Methods: This study was a retrospective case series study. From June 2016 to June 2023, 12 patients (8 males and 4 females, aged 58 to 76 years) with cutaneous malignant tumors in the groin or thigh who met the inclusion criteria were admitted to the Department of Burn Plastic Surgery and Wound Healing of the 988th Hospital of the Joint Logistics Support Force of PLA. In all patients, the depth of tumor invasion extended close to the major vessels and/or nerves. Radical extended resection of the tumors was performed, resulting in postoperative soft tissue defects ranging from 16 cm×13 cm to 37 cm×17 cm in size. A pedicled double-perforator flap of the inferior epigastric artery based on the paraumbilical and thoracic paraumbilical perforators was designed and harvested, with flap dimensions ranging from 15 cm×14 cm to 38 cm×18 cm. The flaps were transferred to the recipient site wound through a subcutaneous tunnel and sutured in place. Primary closure of the donor site wound was achieved in 8 patients; in the remaining 4 patients, the donor site wound was first approximated with sutures to reduce its size, then covered with negative-pressure sealing drainage dressing, with secondary closure performed at a later stage. Postoperative observations included flap blood supply, flap survival, occurrence of vascular crisis, and wound healing of donor and recipient sites. Operative duration and length of hospital stay of patients were recorded. During follow-up after surgery, tumor recurrence, flap contour, and donor site scar were observed, and whether abdominal wall function was affected by the scar was assessed. Results: All 12 patients achieved good flap blood supply and uneventful survival, with no vascular crisis. Wounds in both donor and recipient sites healed successfully. Operative duration of patients ranged from 2.0 to 3.0 hours, and length of hospital stay ranged from 15 to 24 days, with a mean of 18.6 days. During a follow-up period of 1 to 6 years after surgery, no local tumor recurrence was observed. Some flaps appeared slightly bulky, but their elasticity and texture showed no significant differences compared with the surrounding tissue. The donor site only exhibited a linear scar, with no significant impact on abdominal wall function. Conclusions: For soft tissue defects following resection of cutaneous malignant tumors adjacent to major vessels and/or nerves in the groin or thigh, the pedicled double-perforator flap of the inferior epigastric artery is a viable reconstructive option. This flap provides a large surface area for effective reconstruction while minimizing the impact on aesthetics and function of the donor site. 目的： 探讨带蒂腹壁下动脉双穿支皮瓣修复腹股沟或大腿部位邻近主干血管和/或神经的皮肤恶性肿瘤切除后软组织缺损的临床效果。 方法： 该研究为回顾性病例系列研究。2016年6月—2023年6月，解放军联勤保障部队第九八八医院烧伤整形与创面修复科收治12例符合入选标准的腹股沟或大腿部位皮肤恶性肿瘤患者，其中男8例、女4例，年龄58~76岁。患者肿瘤组织侵袭深度均接近主干血管和/或神经。对肿瘤行根治性扩大切除术，术后软组织缺损面积为16 cm×13 cm~37 cm×17 cm。设计并切取以脐旁穿支及胸脐穿支为蒂的腹壁下动脉双穿支皮瓣，面积为15 cm×14 cm~38 cm×18 cm。将皮瓣经皮下隧道转移至受区创面并缝合固定。对8例患者供瓣区创面行直接缝合；对其余4例患者供瓣区创面则先行拉拢缝合以缩小创面，再以负压封闭引流敷料覆盖，待后期缝合。术后观察皮瓣血运及成活情况、血管危象发生情况及供受区创面愈合情况。记录患者手术时长和住院时间。术后随访时，观察患者肿瘤复发情况、皮瓣外形及供区瘢痕情况，并评估腹壁功能是否受瘢痕影响。 结果： 术后12例患者皮瓣血运良好，顺利成活，无血管危象发生；供受区创面均顺利愈合。患者手术时长为2.0~3.0 h；住院时间为15~24 d，平均18.6 d。术后随访1~6年，未见局部肿瘤复发；部分皮瓣稍臃肿，但弹性、质地均与周围组织无明显差异；供区仅遗留线性瘢痕，对腹壁功能无明显影响。 结论： 对于腹股沟或大腿部位邻近主干血管和/或神经的皮肤恶性肿瘤切除后软组织缺损，可选用带蒂腹壁下动脉双穿支皮瓣进行修复。该皮瓣面积大，可实现有效修复，同时对供区外观、功能影响小。.