探讨带腹壁下血管的脐旁穿支皮瓣应用于大腿或腹股沟区放射性溃疡修复的临床效果。

2016年6月至2024年5月，首都医科大学附属北京积水潭医院烧伤整形与创面修复科收治符合入选标准的大腿或腹股沟区放射性溃疡患者11例，其中男5例，女6例，年龄40~73岁。创面位于腹股沟区者3例，大腿中上段者8例，清创后创面面积为9 cm×6 cm~23 cm×10 cm。采用带腹壁下血管的脐旁穿支皮瓣修复创面，皮瓣切取面积为15 cm×8 cm~28 cm×14 cm。皮瓣转移后供区均拉拢缝合。观察术后皮瓣成活情况、创面愈合情况及供区并发症，记录术前和术中创面组织标本细菌培养结果及溃疡区组织标本病理结果。

创面组织细菌培养阴性者1例、阳性者10例，阳性者中单菌种感染者5例，2种及以上细菌混合感染者5例。术后随访6~24个月，7例皮瓣完全成活，创面一期愈合；2例皮瓣远端小面积坏死，经再次手术后愈合；2例皮瓣完全成活，创面遗留窦口，经换药或手术清创后愈合。所有患者供区创面一期愈合，未见腹壁疝等并发症。

带腹壁下血管的脐旁穿支皮瓣血供可靠、组织量充分且血管蒂较长，是修复大腿或腹股沟区放射性溃疡的有效方法。

To evaluate the clinical outcomes of paraumbilical perforator flaps with inferior epigastric vessels for the repair of radiation-induced ulcers on the thigh or inguinal regions.

From June 2016 to May 2024，11 patients with radiation-induced thigh or inguinal regions ulcers who met the inclusion criteria were admitted to the Department of Burn and Plastic Surgery of Beijing Jishuitan Hospital，Capital Medical University. There were 5 males and 6 females，aged 40 to 73 years. The wounds were located in the inguinal region in 3 cases and in the middle-upper thigh in 8 cases. After debridement，the wound area ranged from 9 cm×6 cm to 23 cm×10 cm. Paraumbilical perforator flaps with inferior epigastric vessels were used to repair the wounds，with flap area ranging from 15 cm×8 cm to 28 cm×14 cm. The donor sites were all closed by direct approximation after flap transfer. Postoperative flap survival，wound healing，and donor site complications were observed. Preoperative and intraoperative bacterial culture results of wound tissue specimens and pathological results of ulcer tissue specimens were recorded.

Bacterial cultures of wound tissue were negative in 1 case and positive in 10 cases. Among the positive cases，5 had monomicrobial infection and 5 had polymicrobial infection （≥2 bacterial species）. During postoperative follow-up of 6 to 24 months，7 flaps survived completely with primary wound healing； 2 flaps developed distal marginal necrosis and healed after revision surgery； 2 flaps survived completely but with persistent sinus tracts，which healed after dressing changes or surgical debridement. All donor sites healed primarily，with no complications such as abdominal wall hernia observed.

The paraumbilical perforator flap with inferior epigastric vessels is characterized by reliable blood supply，adequate tissue volume，and long vascular pedicle. It is an effective technique for the repair of radiation-induced ulcers on the thigh or inguinal regions.