股前外侧皮瓣游离移植修复下肢及足部皮肤软组织缺损的临床应用  

Application of anterolateral thigh free flap for skin and soft tissue defects of lower limb and foot

作　　者：张滋洋[1] 施佳[1] 马建华 郭晓征[3] 聂铭博[1] 康皓[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院骨科,武汉430030 [2]湖北省宜都市第一人民医院骨一科 [3]天津港口医院骨科

出　　处：《骨科》2015年第5期226-230,共5页ORTHOPAEDICS

基　　金：国家自然科学基金面上项目(No.81472106);国家自然科学基金青年基金(No.81401538)

摘　　要：目的探讨股前外侧皮瓣游离移植修复下肢及足部软组织缺损的临床疗效。方法选取2014年4月至2015年5月间,使用股前外侧皮瓣游离移植治疗下肢及足踝部软组织缺损的8例患者。术前通过B超及CT血管造影(computed tomography angiography,CTA)定位穿支血管的位置,术中对比血管定位位置后进行血管蒂分离。皮瓣切取面积为15 cm×15 cm^25 cm×15 cm。本组患者由于受区感觉神经缺损,均未进行受区感觉神经的修复。术后随访3个月以上,观察患者皮瓣外观及功能。结果 8例患者中,7例患者皮瓣术后存活,皮瓣对患处覆盖良好并有较好的外观及功能。1例患者术后第2天出现动脉危象,行探查术后再次出现静脉危象导致皮瓣部分坏死,清除坏死皮瓣组织,进行植皮换药后伤口愈合良好。结论股前外侧皮瓣游离移植是游离皮瓣修复下肢及足踝部皮肤缺损中的经典术式,不仅可以减少患者的供区损伤,受区也可以得到良好的功能修复,但是在治疗过程中必须注意神经功能恢复及患肢的骨性功能恢复。Objective To investigate the curative effect of anterolateral thigh （ALl） free flap m the treatment of lower limb and foot soft tissue defects. Methods A total of eight patients with lower limb and/or foot soft tissue defects enrolled from Apr. 2014 to May 2015 were collected in this study. Preoperative ultrasound and computer tomography were performed to locate the perforator artery, and the exact location of the perforator arteries were compared to the preoperative ones. The flaps ranged from 15 cm× 15 cm to 25 cm× 15 cm. Due to sensory nerve defects in the affected area, the sensory nerves in the affected area were not repaired. During the 3 months follow-up, the appearance of the flap and the functions of the lower limb and foot were observed. Results After surgeries, seven out of eight flaps survived, the flap coverage was acceptable with appropriate appearance and function. One patient had an arterial crisis 48 hours after the operation. An exploratory-operation was performed and venous crisis occurred after the operation resulting in partial flap necrosis. Removal of the necrotic tissue and skin grafting were then performed to cover the wound area. Conclusion Free ALT flap transportation is the classical and appropriate surgical procedure for repairing soft tissue defect of the lower limb and foot. ALT flap can not only reduce donor site secondary injury, but also allows the recipient site to regain its required function. However, more attention should be paid on the recovery of the sensory nerves and fracture bones of the affected area.

关 键 词：外科皮瓣 软组织损伤 显微外科手术 足损伤 腿损伤 

分 类 号：R658.3[医药卫生—外科学]