陳宣志王博輝周惠能Wai-Nang Chao醫學研究所2026-10-299999-12-312015https://handle.ncl.edu.tw/11296/g484dxhttps://scholars.csmu.edu.tw/handle/123456789/36117研究背景及目的：在外傷、燒燙傷及惡性腫瘤病患的重建手術當中，皮瓣佔有重要的角色。在皮瓣的發展史上，腹股溝皮瓣曾立下了里程碑，因為它是第一個成功的游離皮瓣。腹股溝皮瓣的優點包括: 有很好的彈性，比較光滑少毛，以及術後疤痕在腹股溝部位容易隱藏。此皮瓣很適合用來重建四肢、會陰、軀幹及頭頸部。昔日，腹股溝皮瓣曾被廣泛應用，然而隨著其它皮瓣的發展以及此皮瓣存在著某些缺點， 例如血管解剖不恆定、皮瓣肥厚、血管蒂短小等，使腹股溝皮瓣漸漸失去流行。為了加強腹股溝皮瓣的臨床應用，去蕪存菁以及研究出更多有用的創新發明是有必要的。研究方法及材料： 從2010到2014年，我們以創新的軸性自由式(n = 34)或根蒂式(n = 1)腹股溝皮瓣修補35位病患的傷口及組織缺失: 四肢 (n = 28)、臀部(n = 1) 及頭部(n = 6)。此外，我們又以嶄新的嵌合式腹股溝游離皮瓣，為13位有四肢複合組織缺失，以及5位有穿透式組織缺失的患者作重建手術。這些皮瓣的血管供應皆來源於旋髂淺動脈(superficial circumflex iliac artery, SCIA)。收集且分析每位患者的資料:年齡、性別、病灶的起因及部位、皮瓣大小、起源於旋髂淺動脈的分枝數目、受區血管、併發症及門診追蹤時間等。研究結果：在接受自由式腹股溝皮瓣重建手術的患者中，門診追蹤了2至38個月(平均15.6個月)，所有皮瓣都存活。在每側旋髂淺動脈的分枝當中可用作軸性皮瓣設計的有2至4條(平均數是3.1條)。皮瓣大小從1.0×1.5公分至11×30公分。所有患者都沒有出現與此皮瓣手術相關的併發症。另外在接受嵌合式腹股溝游離皮瓣重建的患者中，所有皮瓣也順利存活。無論在皮瓣的供區或受區都沒有出現併發症。嵌合式腹股溝游離皮瓣的種類有3種: 皮-皮型(n = 12), 肌-皮型(n = 1) 及骨-皮型(n = 5)。皮瓣大小從1.5×6.0公分至11×30公分，骨瓣大小從1.0×1.5公分至2.5×6.0公分。手術後患者在門診追蹤2至42個月，對於功能及外觀的恢復絕大多數患者都很滿意。結論：這些創新的設計讓腹股溝皮瓣再進化，不但保留了腹股溝皮瓣的原有優點，更發掘了許多新優點：(1)皮瓣血循更可靠使皮瓣存活率更高，(2)皮瓣大小厚薄可依傷口大小作裁剪，(3)皮瓣的血管蒂可作調整「加長」，(4)用一個(嵌合式)皮瓣可同時修補或重建兩個獨立創面或複合性傷口，(5)以局部麻醉也可完成游離皮瓣重建手術，開創皮瓣顯微手術的新領域。Background: Flaps play an important role in reconstructive surgery for trauma patients, burn patients, and cancer patients. In the history of flap development, the groin flap represents a milestone because it was the first successful free cutaneous flap. Some advantages of the groin flap include good pliability, hairless skin, and an inconspicuous donor site. It is a good option for reconstruction in the extremities, perineum, trunk, head, and neck. Once widely used, it is less popular today because of its noted shortcomings, including other flap development, arterial anatomical variation, bulkiness, and the small, short pedicle. To enhance the clinical applications of the groin flap, its merits need to be promoted and its faults improved, including making some useful innovations.Methods and Materials: From 2010 to 2014, we treated 35 patients with soft tissue defects in the extremities (n = 28), buttock (n = 1), and head (n = 6) using new freestyle designs in groin flaps: axial free (n = 34) and pedicle (n = 1) groin flaps. Furthermore, we used the noval chimeric groin free flap designs to reconstruct the composite extremity defects in 13 patients, and the through-and-through oral defects in 5 patients. The flaps were based on the superficial circumflex iliac artery (SCIA). For each patient, the following data were collected: age, gender, cause and site of lesion, flap size, number of branches from the SCIA, recipient vessels, complications, and follow-up time.Results: In the patients underwent reconstruction with freestyle groin flaps, all flaps survived smoothly in the 2 to 38 (mean = 15.6 months) months’ follow-up. The branches of the superficial circumflex iliac artery used for the axial flap design were 2 to 4 (mean = 3.1). The flap size ranged from 1.0×1.5 cm to 11×30 cm. No significant complications developed in any of the patients. In the patients repaired with chimeric groin free flaps, all flaps survived, and no significant complications developed at recipient or donor sites. The types of chimeric groin free flaps included cutaneous-cutaneous (n = 12), musculo-cutaneous (n = 1), and osteo-cutaneous (n = 5) flaps. The cutaneous flap size ranged from 1.5×6.0 cm to 11×30 cm, and the bone flap size ranged from 1.0×1.5 cm to 2.5×6.0 cm. Functional recovery after reconstruction was satisfactory in most patients after a mean of 17.3 months (ranging from 2 to 42 months) of follow-up.Conclusion: These innovative groin flap designs not only preserves the earlier merits of the groin flap, but also creates many new advantages: (1) reliability is greater, (2) ability to tailor the dimensions and flap paddles to the lesions, (3) options available to “lengthen” flap pedicles, (4) ability to reconstruct either two defects or a composite defect using only one (chimeric) flap, and (5) local anesthesia usable with free flaps for reconstruction.腹股溝皮瓣Groin flapthesis