旋股外侧动脉降支多叶组织瓣修复多指（趾）软组织缺损  

Repair soft tissue defects of multiple-fingers/toes with multiplefoliated flap pedicled by descending branch of lateral circumflex femoral artery

作　　者：张文亚[1] 张明[1] 胡宇湘 伍辉国 宋东宁[1] 侯桥[1] 

机构地区：[1]浙江台州骨伤医院手外科,温岭317500

出　　处：《中华骨科杂志》2010年第3期269-272,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨应用旋股外侧动脉降支为蒂的一蒂多叶组织瓣一次修复多指（趾）软组织缺损的方法和临床效果。方法2005年6月至2008年12月，收治8例多指（趾）软组织缺损患者，男5例，女3例；年龄22-38岁，平均27．6岁。设计以旋股外侧动脉降支的肌皮穿支或肌间隙穿支为蒂形成股前外侧穿支皮瓣，带股外侧皮神经前支；以股外侧肌肌支、股直肌肌支、股中间肌肌支、远端肌间隔支为分叶瓣，依受区缺损面积及各指（趾）蹼间距切取各组织瓣，在肌瓣上植全厚皮，一次修复手（足）部创面。结果术后8例患者均未发生血管危象，植皮均成活。全部病例获6个月～3年（平均10．5个月）随访，修复各创面外形均良好，无臃肿，植皮处轻微挛缩。肌瓣植皮处恢复保护性感觉，各皮瓣两点辨别觉约8-10mm。修复1例左足一至三趾软组织缺损病例，术后患足无疼痛及不适，负重行走正常；修复7例手部缺损病例，按中华医学会手外科学会上肢部分功能评定试用标准进行评价：优1例，良4例，可2例，优良率71％。结论以旋股外侧动脉降支为蒂多叶组织瓣能一次修复多指（趾）软组织缺损，仅需吻合一组血管，无需行分指及整形手术，是修复多指（趾）软组织缺损的理想方法。Objective To investigate the methods and effects of muhiplefoliated flap pedicled by descending branch lateral circumflex femoral artery to repair soft tissue defects of muhiplefingers/toes. Methods From June 2005 to December 2008, 8 patients with soft tissue defects of multiple-fingers/toes were repaired with muhiplefoliated flap pedicled only by descending branch lateral circumflex femoral artery. Five of them are male and three of them are female, with average age of 27.6 years （range, 22-38 years）. An- terolateral thigh perforator flaps with lateral femoral cutaneous nerve pedicled by musculocutaneous perfora- tor or spatium intermusculare perforator of descending branch of lateral circumflex femoral artery, muscle flaps pedicled by branches of vastus lateralis muscle, rectus femoris muscle, vastus intermedius muscle and distal spatium intermusculare perforator of it respectively were designed to repair soft tissue defects of multi- ple-fingers/toes, at the same time muscle flaps were covered by skin graft, so the soft tissue defects were re- paired in one time. Results No vascular crisis happened in eight cases and all skin grafts survived. All cases were followed up from 6 months to 3 years （the average was 10.5 months）. The contour of repaired area was good except that the skin grafts had little contracture. Two point discrimination （2-PD） was 8-10 mm of every flap and protective feeling was recovered by skin grafts of every muscle flap. There were no pain and malaise repaired left toe, the second and third toes, weight-bearing and walking were normal. In seven cases of hand soft tissue defects, 1 case was excellent, 4 cases were well and 2 cases were good according to upper extremity function evaluation criteria of Chinese Medical Society for the Surgery of the Hand, the rate of good was 71 percent. Conclusion Soft tissue defects of multiple-fingers/toes can be repaired by multiplefoliated flap only pedicled by descending branch of lateral circumflex femoral artery. Its advantages are only one

关 键 词：外科皮瓣 软组织损伤 指 趾 

分 类 号：R658[医药卫生—外科学]