旋股外侧动脉降支逆行转位修复小腿严重创伤性皮肤软组织缺损  

Treatment of the soft tissue defects in the lower leg after severe trauma using the reversed descending branch of the lateral circumflex femoral artery as the recipient artery

作　　者：冯仕明[1] 王爱国[1] 高顺红[2] 

机构地区：[1]徐州市中心医院手足显微外科,221009 [2]唐山市第二医院手外二科

出　　处：《中华骨科杂志》2013年第10期1053-1057,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨采用旋股外侧动脉降支逆行转位作为受区血管蒂修复小腿严重创伤性皮肤软组织缺损的疗效。方法回顾性分析2007年2月至2012年10月，采用旋股外侧动脉降支逆行转位作为受区血管蒂并与游离组织皮瓣（背阔肌皮瓣或股前外侧皮瓣）的主干血管相吻合修复23例小腿严重创伤性皮肤软组织缺损患者资料，男14例，女9例；年龄22-49岁，平均31．7岁；右侧13例，左侧10例；患肢均无局部皮瓣可供转位修复创面且只有一条主干血管或侧支血管供应远端，创面周缘无可携带游离组织皮瓣的血管蒂。损伤性质：交通伤12例，重物砸伤8例，机器绞伤3例。创面部位：小腿近端4例，小腿近中端12例，小腿中远端7例。皮肤软组织缺损面积为14cm×5cm-32cm×12cm，皮瓣切取面积为15cm×7cm-34cm×13cm。皮瓣供区直接缝合或中厚皮片游离植皮。结果23例皮瓣全部成活，愈合时间为14-30d，其中1例患者术后因感染出现皮瓣远端部分坏死，经换药治疗后创面闭合。无一例皮瓣术后发生血管危象；皮瓣供区切口一期愈合，植皮顺利成活。所有患者均获得随访，随访时间6－21个月，平均12．4个月。末次随访时皮瓣外形、质地、厚薄及色泽均较满意：皮瓣均恢复保护性感觉，两点辨别觉为10-25mm；患者均对术后疗效表示满意。结论旋股外侧动脉降支逆行转位修复小腿严重创伤性皮肤软组织缺损的方法，具有血供可靠，术后疗效满意，术后患者无需被迫体位固定等优点。Objective To investigate the application and clinical result of treatment soft tissue defect in the lower leg after severe trauma by using the reversed descending branch of the lateral circumflex femoral artery of the injured leg as the recipient artery for free flaps. Methods Twenty-three patients with soft tissue defect of the lower leg after severe trauma from Febru- ary 2007 to October 2012 were retrospectively analyzed. The patients were treated with the free flaps （the latissimus dorsi flap or the anterolateral thigh flap） using the reversed descending branch of the lateral circumflex femoral artery of the injured leg as the recipient artery. There were 14 males and 9 females, with an average age of 31.7 years （range, 22-49 years）. The causes of injury were traffic accidents in 12 cases, crushing injury in 8 cases, and machinery injury in 3 cases. The defect located at the proximal in 4 cases, the proximal and middle in 12 cases, middle and distal in 7 cases. Sizes of the tissue defect were 14 crux5 cm to 32 emxl2 cm, and the flap sizes were 15 crux7 cm to 34 cm^13 cm. The donor defect was closed directly or resurfaced with a split- thickness skin graft taken from the thigh. Results Twenty-three flaps survived completely. Partial necrosis at the distal edge of the flap occurred in one case, and was healed by secondary intention. No patient needed urgent operative revision due to postop- erative thrombosis of the vessels. All flaps completely survived, without evidence of postoperative insufficiency of the blood sup- ply or venous congestion. The donor skin graft survived and the incision healed by first intention. The mean follow-up period was 12.4 months （range, 6-21 months）. The appearance, texture, color and thickness of flaps in all cases were good at the last follow- up, The flap achieved protective sensation with the two-point discrimination ranging between 10-25 mm. Conclusion Due to the advantages of reliable blood supply, short treatment cycle, and without postoperative forced position,

关 键 词：外科皮瓣 软组织损伤 显微外科手术 

分 类 号：R658.3[医药卫生—外科学]