- 期刊
Using the Pedicle Anterolateral Thigh Flap as an Optional Method in Fournier's Gangrene Wound Reconstruction
以根蒂式股前外側皮瓣作為佛耳尼埃式壞疽清瘡術後傷口覆蓋的良好選擇
摘要
佛耳尼埃式壞疽是發生於生殖器，會陰部，肛門周圍的壞死性筋膜炎。治療成功的關鍵在於早期診斷，即時清瘡，配合輸液及抗生素使用。在積極清瘡手術，病情穩定之後，男性病人往往會有睪丸暴露，及肛門周圍組織脆弱易碎的問題，為了兼顧重建之後的外觀及睪丸的保護，重建以皮辦轉移為一較恰當的方式。基於我們對於大腿血管解剖學上的熟悉，根蒂式股前外側皮辦是我們的優先選擇。由2005至2006年中，一共有7位病人接受根蒂式股前外側皮辦轉移手術重建會陰部。手術方式及病患治療經過在文中有詳盡的說明。 結論：根蒂式股前外側皮辦的血液循環穩定，血管莖粗且長，很適合會陰部下腹部及肛門周圍缺損的覆蓋，術後病人的外觀自然，步態正常，局部不舒適的情況發生率低，對佛耳尼埃式壞疽清瘡術後的重建是一個很好的選擇。
關鍵字
無資料並列摘要
Fournier's gangrene is the progressive necrotizing infection of the perineum and genital fascia with gangrene of the overlying skin. The effective treatment includes aggressive debridements, broad-spectrum antibiotics, and intensive supportive care. Radical debridements often result in spermatic cord and testis exposure and need secondary reconstruction after infection controlled. How to achieve a cosmetic and functional reconstruction is a challenge. We provide our experience in scrotum reconstruction using the pedicled anterolateral thigh flap. From October 2005 to August 2006, there were seven patients who received pedicled anterolateral thigh fasciocutaneous flaps transfer for the complex perineal defects at the China Medical University Hospital. There were six male patients and one female patient, aged from 45 to 70 years old. The seven patients received one to three times wound debridements and were finally resurfaced with a pedicle anterolateral thigh fasciocutaneous flap transfer, to cover the scrotum, perianal, or lower abdominal skin defect. No cutaneous flap suffered from partial necrosis after transfer. There are two patients who received the split skin graft simultaneously with flap transfer for bigger abdominal defect. The size of the flaps ranged from 50 to 180 centimeter square and was supplied by single perforator. Post-operation wound healing and outlook is very good. Pedicle anterolateral thigh fasciocutaneous flap is a good surgical option in Fournier's gangrene reconstruction. The skin paddle can be adjusted geographically to match the critical defect and the pedicle length can be easily lengthened by ”pedicle extension technique”. The outlooks of the results are natural and less post-op morbidity were noted in our series.
延伸閱讀
- Huang, C. C., Tseng, C. E., Hsu, H., Chien, S. H., & Lin, S. P. (2022). 帶莖的前外側股皮瓣合併人工網膜使用於滑膜肉瘤切除後的腹壁重建－個案報告. 臺灣整形外科醫學會雜誌, 31(2), 123-134. https://www.airitilibrary.com/Article/Detail?DocID=a0000593-202206-202206300023-202206300023-123-134
- Hsieh, M. C. W., Lin, Y. N., Hou, M. F., Yang, F. O., Lee, S. S., Kuo, Y. R., & Lin, S. D. (2021). 大範圍帶莖橫向腹直肌肌皮瓣於巨大葉狀瘤術後大傷口重建之應用. 臺灣整形外科醫學會雜誌, 30(2), 59-67. https://www.airitilibrary.com/Article/Detail?DocID=a0000593-202106-202109090018-202109090018-59-67
- Hsu, K. F., Chen, C. Y., Chu, T. S., Liu, H. H., Chang, C. K., Wu, C. J., Wang, C. Y., Chou, C. Y., Lin, C. T., Dai, N. T., Tzeng, Y. S., Chen, S. G., Chen, T. M., & Wang, C. H. (2018). 梭狀細胞鱗狀細胞癌手術切除術後需術後輔助放療的傷口，使用人造真皮（Terudermis^®）隨後施行分層厚度皮膚移植可能是個可靠的傷口重建選擇－個案報告. 臺灣整形外科醫學會雜誌, 27(3), 206-213. https://www.airitilibrary.com/Article/Detail?DocID=a0000593-201809-201810120027-201810120027-206-213
- Chen, C. K., Hsu, W. M., Lin, Y. S., Chao, W. N., Shih, T. Y., & Liu, C. L. (2010). 利用骼淺迴旋動脈穿支島狀腹股溝皮瓣一次完成廣泛外生殖器缺損的修補. Formosan Journal of Surgery, 43(2), 72-80. https://doi.org/10.29833/FJS.201004.0003
- Wang, G. C., Hsiao, H. T., Tsai, Y. F., Tung, K. Y., Liou, C. J., & Leu, Y. S. (2004). 前外股穿通枝皮瓣與橈側前臂皮瓣和直接縫合法在舌半切除術後功能之比較. 中華民國整形外科醫學會雜誌, 13(4), 253-263. https://doi.org/10.7096/JPSA.200412.0253