股前外侧肌皮瓣修复小腿截肢残端软组织缺损  

Anterolateral musculocutaneous flap for reconstruction of bone expose of lower leg amputation stump which on the verge of reamputation

作　　者：詹翼[1] 戚剑[1] 周翔[1] 傅国 王东[3] 朱庆棠[1] 顾立强[1] 刘小林[1] Zhan Yi;Qi Jian;Zhou Xiang;Fu Guo;Wang Dong;Zhu Qingtang;Gu Liqiang;Liu Xiaolin(Department of Microsurgery and Orthopedic Trauma, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China)

机构地区：[1]中山大学附属第一医院显微创伤外科,广州510080 [2]暨南大学附属第一医院创伤骨科 [3]中山大学附属第七医院骨科

出　　处：《中华显微外科杂志》2018年第6期521-524,共4页Chinese Journal of Microsurgery

基　　金：国家公益性行业科研专项项目(20140216)。

摘　　要：目的 探讨股前外侧肌皮瓣修复小腿截肢残端软组织缺损,保留小腿长度或膝关节以利于假肢装配.方法 2013年4月-2016年11月,应用股前外侧肌皮瓣对小腿截肢残端软组织缺损进行修复4例,其中游离肌皮瓣3例,带蒂肌皮瓣1例.患者均为男性,截肢肌创面位于小腿近端,年龄8~48岁,平均20岁,创面面积7.0 cm×6.0 cm^25.0 cm×10.0 cm.一期清创后二期修复,肌皮瓣面积13.0 cm×10.0 cm^28.0 cm×12.0 cm,保留胫骨长度5.2~9.4 cm.结果 肌皮瓣全部成活,1例肌皮瓣边缘出现浅表感染经换药处理后愈合,供区无并发症.所有患者随访12~37(平均19)个月,末次随访时皮瓣血运好、质地柔软、耐磨.皮瓣感觉恢复程度:S22例, S31例,S3+1例. 6 min步行测试:Ⅳ级2例,Ⅲ级2例;Stanmore运动分级:V级2例,Ⅳ级2例.结论 股前外侧肌皮瓣是修复小腿截肢残端软组织缺损的理想皮瓣.Objective To explore the curative effect of anterolateral musculocutaneous flap to repair the soft defect of the lower leg amputation stump which on the verge of reamputation, and preserved the length of leg or the knee joint to improve prosthetic limb function. Methods Four patients with soft defect and bone expose of proxi-mal leg amputation stump were enrolled in this study from April, 2013 to November, 2016. Each patient underwent stump revision using anterolateral musculocutaneous flap, including 3 free musculocutaneous flaps and 1 pedicle mus-culocutaneous flap. The patients were all male with the mean age of 20(8-48) years. The wound was treated debride-ment, and reconstructed on the second stage. Defect area was from 7.0 cm×6.0 cm to 25.0 cm×10.0 cm. Anterolateral musculocutaneous flaps was from 13.0 cm×10.0 cm to 28.0 cm×12.0 cm. The length of preservation tibia stump was from 5.2 cm to 9.4 cm. Results All patients were followed-up from 12 months to 37 months (average, 19 months). All the musculocutaneous flaps survived completely with a soft tissue texture, elastic, and very wear-resisting. The sensory return was determined to be S2in 2 patients, S3in 1 patient and S3+ in 1 patient. The 6-Minute Walk Test:grade Ⅳ in 2 cases, grade Ⅲ in 2 cases; Stanmore movement classification: gradeV in 2 cases, grade Ⅳ in 2 cases. Conclusion The anterolateral musculocutaneous flap maybe is an ideal flap to provid stable coverage for the stump of leg amputation which on the verge of reamputation.

关 键 词：股前外侧肌皮瓣 截肢 重建 显微外科技术 

分 类 号：R658.3[医药卫生—外科学]