旋股外侧动脉降支分叶穿支皮瓣临床应用16例  

Clinical application of the polyfoliate perforator flap with decending branch of the lateral circumflex femoral artery： 16 cases report

作　　者：吴攀峰[1] 唐举玉[1] 李康华[1] 梁捷予[1] 俞芳[1] 周征兵[1] 

机构地区：[1]中南大学湘雅医院手显微外科,长沙410008

出　　处：《中华显微外科杂志》2015年第6期526-529,共4页Chinese Journal of Microsurgery

基　　金：国家自然科学基金项目（81472104）

摘　　要：目的 探讨吻合血管的旋股外侧动脉降支分叶穿支皮瓣修复肢体复杂性创面缺损的临床方法和经验. 方法 2008年5月至2014年6月,对外伤后所导致的邻近创面、洞穿性缺损、宽大不规则创面,根据旋股外侧动脉降支的走行及分支特点,术前Doppler定位,术中采用吻合血管的旋股外侧动脉降支分叶穿支皮瓣进行修复16例肢体复杂性创面缺损,不携带阔筋膜,供区一期闭合.通过术后随访观察皮瓣供区与受区的外形及功能,评价其临床疗效. 结果 本组15例顺利成活,创面Ⅰ期愈合,皮瓣供区均直接缝合,经1～30个月随访（平均8个月）,皮瓣色泽正常,质地良好,皮瓣供区仅留线性瘢痕.1例皮瓣一叶部分坏死,经扩创植皮后愈合. 结论 旋股外侧动脉降支分叶穿支皮瓣共用一个血管蒂,不携带阔筋膜,只牺牲一个供区,是修复肢体外伤后邻近创面、洞穿性缺损、宽大不规则创面的一种较好的方法.Objective To describe a technique to achieve primary donor-site closure, extend applications and minimize donor-site morbidity by applying the double skin paddle principle.Methods All 16 cases of the double skin paddle anterolateral thigh perforator flap reconstruction from May, 2008 to June, 2014 were reviewed.Defects locations included calf, dorsum pedis or planta pedis.A long anterolateral thigh perforator flap was marked out using standard points of reference.At least two separate cutaneous perforator vessles were identified on hand-held Doppler.Separating and dissecting flap at superficial layer of fascia lata was adopted in all cases.Then skin paddle was then divided between the two cutaneous perforators to give two separate paddles with a common vascular supply which was the descending branch of the lateral circumflex femoral artery.The skin paddles could be used to cover complex skin defects, whilst still allowing for primary donor-site closure.Results Fifteen patients were successfully treated with the double skin paddle anterolateral thigh perforator flap with no major complications.One case was suffered with partial skin flap necrosis.The type A dumbbell-like flaps was used to cover defects involving two different units of the foot.The type B pattern were stacked side by side on a flap inset, effectively doubling the width of the flap, to resurface a large defect of a single unit of the calf.The type C pattern was used to repair adjacent skin defects.In all cases, the donor site was closed directly.All patients were satisfied with their outcomes.Conclusion The double skin paddle anterolateral thigh perforator flap is an excellent method of resurfacing large defects of the extremity involving multiple subunits with improved morbidity and cosmesis of the donor site.

关 键 词：分叶皮瓣 旋股外侧动脉降支 穿支皮瓣 修复 

分 类 号：R622[医药卫生—整形外科]