股前外侧皮瓣游离移植同时修复趾伸肌腱和足背创面  

ANTEROLATERAL THIGH FLAP FOR REPAIR OF TOE EXTENSOR TENDON AND DORSAL FOOT WOUND

作　　者：唐继全[1] 甘干达[1] 陶智刚[1] 罗平[1] 黄育胡[1] 

机构地区：[1]解放军第181医院创伤显微外科,广西桂林541002

出　　处：《中国修复重建外科杂志》2011年第4期423-426,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结应用股前外侧皮瓣游离移植同时修复趾伸肌腱和足背创面的方法及临床疗效。方法 2007年2月-2009年5月,收治11例伴趾伸肌腱损伤的足背复合组织缺损患者。男8例,女3例;年龄10～60岁,中位年龄45岁。致伤原因:锐器伤3例,压砸伤3例,交通事故伤5例。其中新鲜创面7例,受伤至入院时间为2～8h;陈旧创面4例,受伤至入院时间为3～15d。创面范围6cm×5cm～25cm×15cm。均合并趾伸肌腱缺损,其中第2～5趾1例,第3～5趾1例,第2～4趾2例,第2、3趾3例,第1、2趾1例,足趾3例。一期手术采用大小为8cm×7cm～27cm×15cm的股前外侧皮瓣修复创面,同时利用阔筋膜桥接趾长伸肌腱两断端。供区直接拉拢缝合或取中厚皮片移植修复。术后2～3个月二期手术松解肌腱、阔筋膜,并将阔筋膜分割制成肌腱样形态,术后加强足趾功能锻炼。结果一期术后皮瓣均成活,创面Ⅰ期愈合;供区植皮成活,切口Ⅰ期愈合。二期术后7d3例皮瓣出现边缘坏死,宽0.5～2.0cm,经换药后15～20d愈合;其余患者皮瓣均成活,切口Ⅰ期愈合。二期术后8例获随访,随访时间12～18个月,平均15个月。4例皮瓣稍臃肿,其余皮瓣外形满意;皮瓣质地柔软,两点辨别觉为1～3cm。随访期间5例恢复部分背伸功能,背伸5～40°,屈曲功能基本正常;3例背伸功能丧失,但不影响足趾屈曲功能,患者行走正常。无足趾下垂畸形发生。结论股前外侧皮瓣游离移植可以同时修复趾伸肌腱和足背创面,具有治疗时间短、对供区损伤小的特点,避免了术后出现足趾下垂畸形,可获得良好的临床效果。Objective To summarize the method and the clinical outcome of repairing both toe extensor tendon and dorsal foot wounds with anterolateral thigh flap.Methods Between February 2007 and May 2009,11 patients with toe extensor tendon and dorsal foot defect were treated with anterolateral thigh flap.There were 8 males and 3 females with a median age of 45 years（range,10-60 years）.The causes of injury were sharp injury in 3 cases,machine crush injury in 3 cases,and traffic accident injury in 5 cases,including 7 cases of fresh wounds with a disease duration of 2-8 hours and 4 cases of old wounds with a disease duration of 3-15 days.The size of wound ranged from 6 cm × 5 cm to 25 cm × 15 cm.All cases complicated by toe extensor tendon defect,which were located at the 2nd-5th toes in 1 case,3rd-5th toes in 1 case,2nd-4th toes in 2 cases,2nd and 3rd toes in 3 cases,1st and 2nd toes in 1 case,and 1st toe in 3 cases.In the first stage,the anterolateral thigh flap ranged from 8 cm × 7 cm to 27 cm × 15 cm was used to repair defect and fascia lata was used to bridge two ends of digitorum longus tendon;the donor site was sutured or repaired with the skin graft.The second stage was performed after 2-3 months,tenolysis for tendon was performed,and fascia lata was split into tendon-like shape;and the toe functional exercises were done.Results All flaps survived completely after the first stage,wounds healed by first intention;the donor skin graft survived and incisions healed by first intention.At 7 days after the second stage,marginal necrosis occurred in 3 flaps（0.5-2.0 cm in width）,and healed after 15-20 days of dressing change;the other flaps survived,and incisions healed by first intention.Eight patients were followed up 12-18 months（mean,15 months）.Excepts 4 slight bulky flaps,the other flaps had satisfactory appearance and soft texture with two points discrimination of 1-3 cm.During the follow-up,part of the dorsiflexion function recovered in 5 patients（5-40°）,and flexion function was normal;3 dorsiflexi

关 键 词：股前外侧皮瓣 趾伸肌腱 足背复合组织缺损 修复 

分 类 号：R658.3[医药卫生—外科学]