股前外侧游离穿支皮瓣移植修复头面四肢肿瘤切除术后的软组织缺损(英文)  

Anterolateral thigh perforator free flaps transplantation for repair of head and extremeties soft tissue defects after tumor resection○

作　　者：李利平[1] Peter C.Neligan 姚刚[3] 

机构地区：[1]南华大学第一附属医院烧伤整形外科,湖南省衡阳市421001 [2]多伦多大学外科学系整形外科专业 [3]江苏省人民医院,江苏省南京市210029

出　　处：《中国组织工程研究与临床康复》2007年第25期5027-5031,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:传统股前外侧皮瓣移植的临床应用已非常广泛,新一代带穿支游离皮瓣移植在国内尚处于初始阶段。目的:观察头面部和四肢肿瘤切除术后应用股前外侧穿支皮瓣移植修复方法及其修复效果。设计:病例分析。单位:南华大学第一附属医院。对象:选择2004-04/2006-04在南华大学第一附属医院烧伤整形外科及多伦多大学多伦多总医院整形外科收治的16例需要皮瓣移植的患者,所有患者软组织缺损不能直接缝合导致肌腱、血管、神经、骨质外露。男13例,女3例,年龄26～72岁。因头面肿瘤切除后造成软组织缺损、骨质外露修复9例,平均50岁;因四肢肿瘤切除术后造成软组织缺损、骨质外露修复7例,平均为39岁,所有患者均对手术项目知情同意。方法:患者均采取全身麻醉,气管插管。医生分两组同时或先后进行手术。肿瘤切除由头颈外科或骨外科医生承担,肿瘤切除后由整形外科医生承担修复任务,整形外科医生先确定受区血管床,并游离,准备好受区血管。其中有2例游离出神经断端做神经修复。根据创口情形切取穿支皮瓣:于髂前上棘及髌骨前外上缘连线作为皮瓣的纵轴线,确定中点,并在中点区域设计所需要的皮瓣。皮瓣最大面积达28cm×15cm,在皮瓣范围内用超声多普勒仪确定主要穿支浅出点(即超声回音最强点)一二个。沿设计线切开皮肤皮下,在放大镜下逐步切开分离皮下组织与深筋膜。遇到主要穿支后,确保一二支主要穿支不受损伤;并沿着穿支血管追踪分离深筋膜、肌肉或肌间隔,及至所需要的血管蒂的长度和所需要的血管管径的大小。必要时保留股前外侧皮神经,本组修复皮神经两例。供瓣区创面直接闭合,放负压引流。在显微镜下用9-0尼龙线吻合血管,用10-0尼龙线吻合神经,间断缝合皮瓣与受区创缘,同时放负压引流于瓣下。头部创口缝线术后9～11d拆除,四�BACKGROUND： Traditional anterolateral thigh flaps transplantation has been widely used in clinics; however, a new generation of perforator free flap transplantation is still in an initial phase at home. OBJECTIVE： To investigate the method, effectiveness and clinical application of anterolateral thigh perforator free flaps transplantation for reconstruction of soft tissue defects of the head and extremeties after tumor resection.DESIGN： Case analysis. SETTING： First Affiliated Hospital of Nanhua University. PARTICIPANTS： A total of 16 patients needing skin flap transplantation were selected from Department of Burns and Plastic Surgery, the First Affiliated Hospital of Nanhua University and Department of Plastic Surgery, General Hospital of Toronto, Toronto University from April 2004 to April of 2006. Soft tissues of all patients could not be directly sutured so as to cause the exposure of tendon, vessel, nerve and sclerotin. There were 13 males and 3 females aged from 26 to 72 years. The anterolateral thigh perforator free flap for reconstruction of the soft tissue defects and/or bone exposure occurred on the head （nine cases, mean age of 50 years） or extremities （seven cases, mean age of 39 years） following tumor resection. All patients provided the informed consent. METHODS： After general anaesthesia with tracheal intubation, a two-team approach was used for resection of the tumor, and harvest of the free flap simultaneously or successively. The tumor was removed by head and neck surgeon or orthopedic surgery. And the plastic surgeons assumed the responsibility for reconstruction of the defects following the tumor resection. The dissection of recipient blood vessels （e.g., superior thyroid artery, facial artery, a branch of internal jugular vein, or external jugular vein, artery and vein of dorsal of foot, anterior tibial artery or vein） was performed. In addition, the ends of sural nerve at recipient sites that need be repaired with the anterolateral thigh cutaneous nerve were utili

关 键 词：股前外侧 穿支皮瓣 修复 软组织肿瘤缺损 皮瓣移植 

分 类 号：R617[医药卫生—外科学]