以单一高位穿支为蒂逆行股前外侧皮瓣修复小腿大面积软组织缺损  

Repair of large area of soft tissue defect of calf by the retrograde anterolateral thigh flap with single high cutaneous perforator

作　　者：胡智玉 幸超峰[1] 熊颖杰 宋力[1] 宋科 张勇[1] 杨瑞甫 李士民[1] 周明武[1] Hu Zhiyu;Xing Chaofeng;Xiong Yingjie;Song Li;Song Ke;Zhang Yong;Yang Ruifu;Li Shimin;Zhou Mingwu(Department of Trauma Orthopedics, the 153rd Central Hospital of PLA, Zhengzhou 450007, China)

机构地区：[1]中国人民解放军第一五三中心医院创伤骨科,郑州450007

出　　处：《中华显微外科杂志》2018年第6期544-547,共4页Chinese Journal of Microsurgery

摘　　要：目的探讨采用以单一高位穿支为蒂股前外侧皮瓣逆行转移修复小腿大面积软组织缺损的临床疗效。方法2014年1月-2017年7月,采用以单一高位穿支为蒂逆行转移股前外侧皮瓣修复小腿大面积软组织缺损患者9例,男7例,女2例;年龄24~48岁。小腿软组织缺损面积为10.0cm×7.0cm^35.0cm×15.0cm,其中包括植皮和皮肤牵张修复的面积。将高位穿支穿出点设计在皮瓣近端,以此穿支作为皮瓣的单一营养血管,并将皮瓣旋转点向大腿近端上移,既增加皮瓣血供又可使皮瓣修复范围向小腿远端下移。皮瓣切取面积15.0cm×10.0cm^22.0cm×12.0cm。术后定期进行随访。结果术中皮瓣切取顺利,术后无血管危象发生,皮瓣均顺利成活。患者均获得随访6~12个月,皮瓣外观饱满稍显臃肿,色泽与受区相似,质地柔软,供区无活动障碍。结论采用单一高位穿支为蒂逆行转移股前外侧皮瓣,可将皮瓣旋转点向近端上移,通过增加其血管蒂与膝上外侧动脉吻合支的数量及口径改善皮瓣的供血和回流,皮瓣的成活率不受影响。相比传统逆行股前外侧皮瓣,该皮瓣有较大优势。ObjectiveTo explore the clinical effect of repairing the large area of soft tissue defect of the calf by the retrograde anterolateral thigh flap with single high cutaneous perforator. MethodsFrom January, 2014 to July, 2017, 9 cases of large area of soft tissue defects were repaired by the retrograde anterolateral thigh flap with single high cutaneous perforator. There were 7 males and 2 females, aged 24-48 years. Soft tissue defects area of the calf was 10.0 cm×7.0 cm to 35.0 cm×15.0 cm, including skin grafting and skin stretch to repair the area. The perforating point of the high cutaneous artery branches was designed at the proximal end of the flap, which was used as the single nutrient vessel of the flap. The rotation point of the flap was moved upward to the proximal thigh, which not only increased the blood supply of the flap, but also made the flap repair range to the distal calf. The flap range was 15.0 cm×10.0 cm to 22.0 cm×12.0 cm. ResultsAll flaps were cut smoothly, and no vascular crisis occurred. All flaps survived smoothly. All patients were followed-up for 6-12 months. The appearance of flaps was plump, slightly bloated, and their color was similar to the recipient area. The texture was soft, and no active disorder in the donor site. ConclusionThe retrograde anterolateral thigh flap with single high cutaneous perforator can be designed at a high rotation point. By increasing the number and caliber of the anastomotic branch between the pedicle and lateral superior genicular artery, the blood supply and reflux of flap can be improved, and the survival rate is not affected. Compared with the traditional anterolateral thigh flap, it has great advantages.

关 键 词：股前外侧皮瓣 高位穿支 小腿 软组织缺损 

分 类 号：R658.3[医药卫生—外科学]