两种术式前臂皮瓣术后前臂供区恢复的比较

doi:10.3969/j.issn.1005-4979.2021.04.06

摘要/Abstract

摘要：

目的： 比较两种类型的前臂皮瓣桡侧术后前臂供区恢复的情况。方法： 回顾我院44例因口腔颌面部肿瘤致术后缺损经游离前臂皮瓣修复的患者。皮瓣由同一经验丰富的医师制取。按照制取皮瓣的方法分为传统的前臂皮瓣（A组），以下简称传统组，改良的前臂皮瓣（B组），以下简称改良组，对其术后半年、术后1年进行随访，针对制取皮瓣的手术时间、皮片面积，术后1个月内前臂供区并发症，前臂供区瘢痕及功能方面进行比较，采用SPSS 16软件进行统计学分析。结果： 改良组与传统组患者皮瓣制取时间、年龄及皮片面积的P值分别为 0.917，0.690，0.771。1月内术后并发症2组比较差异无统计学意义；术后半年A、B 2组在瘢痕评定量表（vancouver scar scale，VSS）中色素沉着、血管分布、柔韧性及高度、总得分方面及disabilities of the arm, shoulder and hand questionnaire （DASH）的功能及症状、总得分方面差异无统计学意义；术后1年A、B 2组在上述方面差异也无统计学意义。结论： 改良组与传统组在供区恢复方面无差异。但改良组避免了传统组需开辟第三术区的问题，减少了手术创伤、患者的痛苦与额外的瘢痕。

关键词: 前臂桡侧皮瓣, 瘢痕, 上肢功能, 前臂供区恢复

Abstract:

Objective: To compare the recovery of function and esthetics of forearm donor area after radial operation of two types of forearm skin flaps. Methods: A retrospective review of 44 patients in our hospital who used free forearm flaps to repair postoperative defects due to excision for oral and maxillofacial malignancy. These flaps were made by the same experienced surgeons. According to the method of operation criteria, it was divided into a traditional forearm flap group,(traditional group), and a modified forearm flap group(modified group).The followe-up period was half a year and one year after the operation. The flap preparation time length, flap size, complications of the forearm donor area within one month after operation, and the keloid （pigmentation, vascular distribution, flexibility and height, and overall score） and function of the forearm donor area were recorded and compared. The statistical analysis was performed using the SPSS 16 software package. Results: In the modified group and the traditional group, P values of the flap preparation time length, patients age, and flap size were 0.917, 0.690, and 0.771, respectively. There was no difference in postoperative complications within one month between the two groups. Half a year after surgery, comparison of two groups between vancouver scar scale (VSS), disabilities of the arm, shoulder, and hand questionnaire(DASH), there was no statistical difference. One year later, the two groups had no statistical significance in the above aspects. Conclusion: There was no difference between the improved group and the traditional group in the recovery of forearm donor area. However, the modified group avoided the need for the third group to open up the traditional surgical area, reducing the surgical trauma, patient pain and additional scars.

Key words: radial forearm flap, scar, upper limb function, forearm donor area recovery

王浩然, 王映, 李志萍, 庄乾伟, 孟箭, 葛良玉. 两种术式前臂皮瓣术后前臂供区恢复的比较[J]. 《口腔颌面外科杂志》, 2021, 31(4): 232-236.

WANG Haoran, WANG Ying, LI Zhiping, ZHUANG Qianwei, MENG Jian, GE Liangyu. Donor site recovery of forearm free flap after operation: Comparison of two different coverage techniques[J]. 《Journal of Oral and Maxillofacial Surgery》, 2021, 31(4): 232-236.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2021/V31/I4/232

图/表 11

图1 传统前臂皮瓣照片 A.传统皮瓣术中照片；B.传统皮瓣术后照片。

Figure 1 Photographs of traditional forearm flap

图2 改良皮瓣示意图

Figure 2 Schematic diagram of modified forearm flap

图3 改良皮瓣照，修复后切口轮廓 A.改良皮瓣术前照；B.改良皮瓣术后照。

Figure 3 Photographs showing the modified forearm flap, outline of incision and after restoration

图4 前臂皮瓣术后1月照 A.传统皮瓣照；B.改良皮瓣照。

Figure 4 Photographs showing forearm flap 1 month after grafting

图5 前臂皮瓣术后半年照 A.传统皮瓣照；B.改良皮瓣照。

Figure 5 Photographs showing forearm flap 6 months after grafting

图6 前臂皮瓣术后1年照 A.传统皮瓣照；B.改良皮瓣照。

Figure 6 Photographs showing forearm flap 1 year after grafting

表1 两组手术时间、患者年龄及皮瓣面积（$\bar{x}\pm s$）

Table 1 Comparison of operation time, patient age and skin flap surface area between two groups（$\bar{x}\pm s$）

组别	手术时间/min	患者年龄/岁	皮瓣面积/cm²
A组	43.29±3.41	61.10±2.33	42.64±1.39
B组	43.39±3.30	59.87±2.00	42.09±1.30
P值	0.917	0.69	0.771

表2 两组术后半年DASH得分情况（$\bar{x}\pm s$，分）

Table 2 Comparison of DASH results between two groups after half a year（$\bar{x}\pm s$, score）

组别	功能	症状	总分
A组	61.33±0.93	17.86±0.42	40.99±0.78
B组	62.39±1.28	19.00±0.56	42.83±1.09
P值	0.514	0.112	0.187

表3 两组术后1年DASH得分情况（$\bar{x}\pm s$，分）

Table 3 Comparison of DASH results between two groups after 1 year（$\bar{x}\pm s$, score）

组别	功能	症状	总分
A组	33.86±0.70	11.76±0.45	13.02±0.81
B组	34.87±0.86	13.48±0.72	15.29±1.19
P值	0.372	0.54	0.127

表4 两组术后半年VSS得分（分，$\bar{x}\pm s$）

Table 4 Comparison of VSS scores between two groups（score, $\bar{x}\pm s$）

组别	色素沉着	血管分布	柔韧	高度	总分
A组	6.57±0.24	7.29±0.37	7.33±0.35	7.05±0.31	28.24±0.74
B组	7.13±0.44	7.70±0.32	7.83±0.42	7.91±0.44	30.57±1.27
P值	0.268	0.40	0.373	0.117	0.122

表5 两组术后1年VSS得分（分，$\bar{x}\pm s$）

Table 5 Comparison of VSS scores between two groups （score, $\bar{x}\pm s$）after 1 year

组别	色素沉着	血管分布	柔韧	高度	总分
A组	2.57±0.24	3.43±0.24	3.33±0.17	3.38±0.24	12.71±0.56
B组	2.91±0.29	3.04±0.21	3.70±0.18	3.83±0.18	13.48±0.52
P值	0.375	0.230	0.160	0.149	0.324

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