穿支血管导航下超薄股前外侧皮瓣临床应用  

Clinical application of ultrathin anterolateral femoral perforator flaps under the assistance of perforator vessel navigation

作　　者：庄加川[1] 李敏姣[1] 陈乐锋[1] 陈国荣[1] 叶学浪[1] 张振伟[1] 

机构地区：[1]广州医科大学附属深圳沙井医院手外科,深圳518104

出　　处：《中华手外科杂志》2015年第2期113-115,共3页Chinese Journal of Hand Surgery

基　　金：深圳市卫生和人口计划生育委员会立项项目（201302170）

摘　　要：目的探讨穿支血管导航下超薄股前外侧皮瓣修复手部创面的临床应用。方法对7例手部皮肤缺损患者，皮肤缺损面积为5．5cm×7．2cm～10．0cm×12．5cm，术前用多普勒探测仪对股前外侧穿支血管进行探测，确定穿支血管的走向及穿出点的位置，精确切取股前外侧皮瓣并剔除多余的皮下脂肪，吻合穿支血管与受区动静脉重建皮瓣血液循环，大腿皮瓣供区直接闭合或部分植皮。结果7例股前外侧游离皮瓣全部存活，1例皮瓣术后出现血管危象，手术探查发现动脉吻合口内有血栓形成，取出血栓后重新吻合血管后皮瓣存活，2例皮瓣术后部分皮缘出现淤黑、干性坏死，直接清创缝合创面。术后随访2个月至2年，平均11个月，手部皮瓣外观满意，7例皮瓣均无需二次整形，手功能恢复良好，大腿供区创面愈合好。按中华医学会手外科学会手功能评定标准评走：优4例，良2例，可1例。结论穿支血管导航下超薄股前外侧皮瓣修复创面是一种较理想的方法。Objective To explore the clinical application of ultrathin anterolateral femoral perforator flap under the perforator vessel navigation to repair skin defects on hand. Methods Seven cases of hand skin defect were included. Skin defect area ranged from 5.5 cm × 7.2 cm to 10.0 cm × 12.5 cm. Perforator and piercing point position were determined by Doppler before operation to detect the anterelateral femoral perforator vessels. During operation, extra subcutaneous fat was removed, and anastomosis of the perforator vessels with the vessels of recipient sites was performed to reconstruct the flap blood circulation. The donor sites were sutured directly or repaired by skin grafting. Results All patients were follow-up for 2 to 24 months, 11 months on average. Anterolateral femoral flaps of 7 eases all survived. Vascular crisis occurred in 1 case, in which thrombosis was found at anastomosis site. The flap was saved by removal of the thrombus. Flap margin necrosis occurred in 2 eases. Both wounds were saved by debridement and sutured directly. All flaps showed satisfactory appearance, no need for secondary procedures. Hand function recovered well, and the thigh donor sites healed well. According to the hand function evaluation standard, 4 eases were excellent, 2 good, and 1 acceptable. Conclusion The ultrathin anterolateral femoral perforator flap transfer under the perforator vessel navigation could be an ideal method to reoair the hand skin defect.

关 键 词：外科皮瓣 手损伤 超薄股前外侧皮瓣 穿支血管导航 

分 类 号：R622.1[医药卫生—整形外科]