Ⅰ期移植复合股前外侧穿支皮瓣治疗ⅢC型开放性损伤  

Primary composite anterolateral thigh perforator flap transfer for treatment of Gustilo type m c open fracture

作　　者：王欣[1] 潘佳栋[1] 黄耀鹏[1] 周丹亚[1] 胡瑞斌[1] 杨科跃[1] 陈宏[1] 章伟文[1] 

机构地区：[1]宁波市第六医院手外科,315040

出　　处：《中华创伤杂志》2014年第5期433-437,共5页Chinese Journal of Trauma

基　　金：宁波市自然科学基金资助项目（2011A610046）;宁波市卫生局资助项目（2010A23）

摘　　要：目的探讨急诊Ⅰ期移植复合股前外侧穿支皮瓣（anterolateralthighperforatorflap，ALTP）挽救濒临截肢患者肢体的手术方法与临床疗效。方法2008年7月1012年12月对9例濒临截肢的患者采用Ⅰ期移植复合ALTP进行保肢手术。所有患者均为交通伤所致的GustiloⅢC型开放性损伤。上肢3例，下肢6例，其中急诊行骨折内固定5例，伴骨缺损Ⅰ期予外固定、Ⅱ期行植骨内固定4例。移植单纯桥接动脉型ALTP4例，单纯嵌合型AL．TP2例，桥接动脉＋嵌合型ALTP2例，桥接动脉＋嵌合＋分叶型ALTP1例。皮瓣切取面积10cm×6cm-22cm×9cm。皮瓣供区创面均Ⅰ期缝合关闭。结果9例患者均保肢成功，6例皮瓣顺利成活，3例皮瓣术后出现张力性水泡，经拆线、针刺放血等治疗后成活。术后随访5—36个月，骨折愈合时间4．5～8个月，平均6．3个月。结论急诊移植复合ALTP手术，既能挽救濒临截肢患者的肢体，又可缩短病程，减少并发症，利于肢体功能的早期恢复。Objective To investigate the procedure techniques and clinical effects for treatment of cases on the brink of amputation with composite anterolateral thigh perforator flap （ALTP） in primary surgery. Methods From July 2008 to December 2012, 9 cases on the verge of amputation received primary composite ALTP transfer to perform limb salvage surgery. All cases were Gustilo type m c open injuries resulted from traffic accidents which involved upper extremities in 3 cases and lower extremities in 6 cases. Emergent fracture fixation was done for 5 cases; primary external fixation followed by definitive bone grafting was done for 4 cases combined with bone defects. Types of flaps consisted of flow-through ALTPs in 4 cases, chimeric ALTPs in 2 cases, flow-through ＋ chimeric ALTPs in 2 cases, flow-through ＋ chimeric ＋ polyfoliate ALTP in 1 case. Size of flaps ranged from 10 cm x 6 cm-22 cm ~ 9 cm. Donor sites were closed primarily. Results Limb salvage succeeded for all the 9 cases. Six flaps survived un- eventfully, but another 3 flaps developed tension blisters and survived eventually after stitches removing and blood-letting. Postoperative follow-up was 5-36 months. All cases achieved bone union in 4. 5- 8 months （ mean, 6.3 months）. Conclusion Emergent composite ALTP transfer can not only save the limb, but also reduce the recovery time and complications and contribute to the early recovery of limb function.

关 键 词：创伤和损伤 四肢 外科皮瓣 保肢 

分 类 号：R658[医药卫生—外科学]