带神经削薄的游离股前外侧穿支分叶皮瓣修复足踝部软组织缺损  

Clinical application of free super-thin anterolateral femoral perforator lobulated skin flap with nerve for repair of tissue defect of the foot and ankle

作　　者：董玉金[1] 张铁慧[1] 钟声[1] 任远飞[1] 

机构地区：[1]大连医科大学附属大连市中心医院手足外科,116033

出　　处：《中华骨科杂志》2016年第13期826-832,共7页Chinese Journal of Orthopaedics

摘　　要：目的：探讨应用带神经削薄的游离股前外侧穿支分叶皮瓣修复足踝部软组织缺损的临床效果。方法回顾性分析2011年1月至2014年12月，采用带神经削薄的游离股前外侧穿支分叶皮瓣修复32例足踝部软组织缺损患者资料，男20例，女12例；年龄21~50岁，平均35.5岁；均为足踝背侧合并足底皮肤缺损，创面均伴有肌腱、骨或内固定外露，缺损面积12 cm×10 cm^20 cm×15 cm。采用超声多普勒确定皮瓣穿支血管部位，并以此为中心，根据缺损创面的形状及大小，设计携带股前外侧皮神经皮瓣，切取该皮瓣，保留大部分阔筋膜，游离皮瓣至仅血管蒂相连时，修薄皮瓣，从外周至血管皮支穿出点附近按次序阶梯样修剪并削除皮下脂肪，皮瓣四周皮下脂肪可完全削去，仅保留真皮层，穿出点周围1.0~2.0 cm组织不予修剪；观察皮瓣血供，防止穿支血管损伤，皮瓣修薄后，形成分叶皮瓣，移植修复足踝部创面。结果32例患者术后无一例发生血管危象，皮瓣均成活，其中1例在术后第5天出现皮瓣远端约1.5 cm×1.0 cm浅表坏死，经换药后愈合。32例患者均获得随访，随访时间6~24个月，平均13个月；术后皮瓣质地柔软，弹性好，无臃肿，肤色接近正常皮肤，感觉功能恢复良好，两点辨别觉为3.0~5.0 mm，足踝功能及外形恢复良好。根据中华医学会手外科学会上肢部分功能评定试用标准，评分为55~100分，平均90分，其中优22例，良9例，可1例，优良率达97%（31/32）。结论带神经削薄的游离股前外侧穿支分叶皮瓣可用于治疗足踝部软组织缺损，术后皮瓣可存活，疗效满意。Objective To explore the clinical outcome of free super？thin anterolateral femoral perforator lobulated skin flap with nerve for repairing the tissue defect of the foot and ankle. Methods Free super？thin anterolateral femoral perforator lob？ulated skin flap with nerve was transferred to repair soft tissue defects of the foot and ankle in 32 cases. There were 20 males and 12 females with an average age of 35.5 years （range, 21-50 years）. The wounds located in dorsal and plantar ankle skin with ten？don, bone and/or internal fixation exposed. The defect area was from 12 cm×10 cm to 20 cm×15 cm. At first the site of perforator vessels were determined by Doppler, according to the wound shape and size, the flaps were designed and harvested with the site as center;the femoral lateral cutaneous nerve was carried and most tensor fascia was reserved. During flap harvesting trimming of the flap was carried out, the flap was freed and only connected with its vascular pedicle. A step？wise defatting was done from the pe？riphery of the flap towards the vascular pedicle with 1.0 to 2.0 cm tissue around the perforator preserved. Flap circulation was care？fully observed to prevent damage to the perforators. The vascular pedicle was disconnected and formed a split leaf skin flap, and then the flap was transferred to the foot and ankle to cover the defect. Results All the 32 flaps were survived. No vascular crisis happened and all skin grafts were survived in donor sites. Necrosis of 1.5 cm×1.0 cm of the distal flap occurred in 1 case five days after surgery and it was healed by dress changing. All the 32 cases were followed？up for 6 to 24 months （average, 13 months）. The flaps were supple and elastic with near normal color. There was no bulkiness. Sensory function was recovered well and two point discrimination （2？PD） was about 3.0-5.0 mm. The function and appearance of the foot and ankle were good. According to the Chi？nese Medical Association of hand surgery upper limb function evaluation of upp

关 键 词：足 踝 外科皮瓣 软组织损伤 显微外科手术 

分 类 号：R658.3[医药卫生—外科学]