股前外侧穿支皮瓣切取技巧分析  

A technique analysis for dissection of anterolateral thigh perforator flap

作　　者：朱跃良[1] 殷作明[2] 王家祥 吕乾[1] 赵泽雨 浦绍全 石健[1] 徐永清[1] 

机构地区：[1]成都军区昆明总医院骨科,昆明650032 [2]西藏军区总医院骨科,拉萨850000 [3]罗平县人民医院骨科,云南罗平655800

出　　处：《中国修复重建外科杂志》2017年第1期57-61,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：成都军区医学科学技术研究计划项目(B14012)~~

摘　　要：目的改进股前外侧穿支皮瓣的切取技巧,减少手术时间。方法选取2008年1月—2015年6月采用股前外侧穿支皮瓣修复的400例患者作为研究对象,分析其皮瓣成功愈合(370例,92.5%)及术后二次探查(30例,7.5%)的技术因素;同时结合文献已报道的皮瓣切取技术,提出一种改良的皮瓣切取技术,即以逆行追踪穿支蒂-顺行切取降支主干的方法切取皮瓣,并于2015年6月—2016年6月应用于100例患者。其中男76例,女24例;年龄11~71岁,平均35.6岁。创面范围8 cm×5 cm^23 cm×9 cm。受伤至手术时间5~31 d,平均14.3 d。结果手术时间为(30.1±19.3)min,较未改进的切取方法手术时间(85.0±30.2)min明显缩短。术后94例皮瓣成活并顺利愈合,创面及切口均Ⅰ期愈合。6例发生血管危象,术后探查发现4例为静脉危象,术后取出血栓,皮瓣完全成活;2例为动静脉危象,探查失败,皮瓣全部坏死后行二期创面植皮+换药后愈合。94例皮瓣成活患者获随访,随访时间3~12个月,平均6.3个月。皮瓣生长良好,其中21例行二期修薄手术。结论改进后的股前外侧穿支皮瓣切取方法可进一步减少手术时间,降低切取难度。Objective To improve the harvesting techniques of anterolateral thigh perforator flap, and to reduce the operation time. Methods Between January 2008 and June 2015, 400 patients undergoing repair with anterolateral thigh perforator flap were induded to analyze the technical factors, including 370 cases （92.5%） obtaining primary healing and 30 cases （7.5%） receiving re-exploration. Combined with the literature, a modified flap dissection was made： reverse tracing and sequential dissection of the descending branch of the lateral circumflex femoral artery. Between June 2015 and June 2016, the modified free anterolateral thigh perforator flap was used in 100 cases. Of 100 cases, 76 were male and 24 were female, aged from 11 to 71 years （mean, 35.6 years）. The wound size ranged from 8 cm×5 cm to 23 cm×9 cm. The time between injury and surgery ranged from 5 to 31 days （mean, 14.3 days）. Results The operation time of modified flap dissection was reduced to （30.1±19.3） minutes from （85.0±30.2） minutes （unmodified flap dissection）. Postoperatively, 94 flaps survived uneventfully, and incision healed by first intention. Six flaps received re-exploration surgery because of vascular compromise; the flap survived after removal of thrombosis in 4 cases of vein thrombosis; the flap necrosed in 2 cases of vein and artery thrombosis, and skin grafting was performed. Ninety-four patients whose flaps survived were followed up 3-12 months （mean, 6.3 months）; the flaps had good color and appearance, and second stage operation was performed to make the flap thinner in 21 cases. Conclusion Improved harvesting technique of free anterolageral thigh perforator flap could decrease surgery time and difficulty in dissection.

关 键 词：股前外侧穿支皮瓣 皮瓣切取 技术改良 

分 类 号：R658[医药卫生—外科学]