带阔筋膜的股前外侧穿支组织瓣修复组织缺损  

Repair of tissue defects with free composite anterolateral femoral fascia lata perforator tissue flaps

作　　者：张万锋[1] 梁锋[1] 李金有[1] 王爱武[1] 张小锋[1] 李林[1] 高秋芳[1] 牛雪涛 马亚军[1] 赵丽靓 

机构地区：[1]陕西省汉中市中心医院烧伤整形科,723000

出　　处：《中华烧伤杂志》2013年第5期427-431,共5页Chinese Journal of Burns

摘　　要：目的观察应用带阔筋膜的股前外侧穿支组织瓣（筋膜瓣或筋膜皮瓣）显微移植修复多个部位复合组织缺损的临床效果。方法2008年2月-2012年8月，笔者单位采用带阔筋膜的股前外侧穿支组织瓣显微修复12例患者复合组织缺损，其中头皮恶性肿瘤切除后头皮、颅骨、硬脑膜缺损2例，跟后区及小腿皮肤、跟腱缺损3例，手背部皮肤、伸指肌腱缺损2例，足踝部皮肤、伸趾肌腱缺损合并骨外露或内同定钢板外露5例。组织瓣切取面积为12cm×6cm-19cm×18cm。供瓣区直接拉拢缝合或植皮修复。结果12例组织瓣术后全部成活，经2～36个月随访，局部外形、质地、功能良好。其中2例头皮恶性肿瘤切除后的头皮、颅骨、硬脑膜缺损修复，肿瘤无复发，脑组织无膨隆外疝；3例跟后区及小腿皮肤、跟腱缺损修复后，足部提踵功能得以重建，按Arner—Lindholm评定法评为优2例、良1例；2例手背部皮肤、伸指肌腱缺损，手指伸指功能按中华医学会手外科学会手部肌腱修复后评定标准均达到良；5例足踝部皮肤、伸趾肌腱缺损合并骨外露或内固定钢板外露修复后，足趾背伸功能得到重建和改善。结论将带阔筋膜股前外侧穿支组织瓣显微移植用于颅骨和硬脑膜缺损修复、跟腱缺损再造、重建足提踵功能及在手足部伸指（趾）肌腱缺损再造修复，是一种有效方法。Objective To observe the clinical effects of repair of complicated tissue defects of sev- eral body parts with composite anterolateral femoral fascia lata perforator tissue flaps （fascial flap or fascial skin flap） with the aid of micro-surgery. Methods From February 2008 to August 2012, complicated tis- sue defects in 12 patients were repaired with composite anterolateral femoral fascia lata perforator tissue flaps. Two of the 12 patients suffered from a defect of scalp, skull, and dura mater as a result of resection of a malignant tumor of the scalp; 3 patients showed a defect of skin and tendo calcaneus in the heel and lower leg; 2 patients showed a defect of skin and extensor tendon in the dorsum of hands; the other 5 patients suf- fered from defects of skin and extensor tendon in the loot and ankle combined with exposure of bone or inter- nal buttress plate. The size of tissue flaps ranged from 12 cm ×6 cm to 19 cm×18 cm. The donor sites were closed by immediate suturing or skin grafting. Results All 12 tissue flaps survived. Patients were fol- lowed up for 2 to 36 months. The flaps were shown to have good appearance, texture and function. Two pa- tients with the defect of the scalp, skull and dura mater after a resection of the malignant tumor of the scalp did not have recurrence or herniation of brain tissue. The foot-raising function in 3 patients with the defect of skin and tendo calcaneus in the heel and lower leg was recovered, and according to Arner-Lindholm criteria the result was excellent in 2 cases and good in 1 case. The extension function of fingers of 2 patients with de- fects of skin and extensor tendon in the dorsum of hands was good according to the evaluation criteria of Chi- nese Medieal Association Society of Hand Surgery for tendon repair of hand. The extension function of toes of 5 patients with defects of skin and extensor tendon in the foot and ankle combined with exposure of bone or internal buttress plate was recovered and improved. Conclusions Transplantation of composite ant

关 键 词：烧伤 软组织损伤 显微外科手术 组织移植 阔筋膜 

分 类 号：R658.3[医药卫生—外科学]