股前外侧皮瓣在儿童四肢创面修复中的应用  

Application of anterolateral thigh flap in repair of extremity wound of children

作　　者：徐永清[1] 何晓清[1] 朱跃良[1] 张旭林[1] 杨曦[1] 王腾[1] 崔轶[1] 徐月仙[1] Xu Yongqing, He Xiaoqing, Zhu Yueliang, Zhang Xulin, Yang Xi, Wang Teng, Cui Yi, Xu Yuexian.(Department of Orthopedic Surgery, Kunming General Hospital of PLA , Kunming 650032, China)

机构地区：[1]成都军区昆明总医院全军创伤骨科研究所,昆明650032

出　　处：《中华创伤杂志》2018年第10期875-880,共6页Chinese Journal of Trauma

基　　金：全军后勤科研计划重大专项（AWS14C003）;全军后勤科研计划面上项目（CCD14J003）

摘　　要：目的探讨股前外侧皮瓣在儿童四肢创面修复中的应用效果及其特点。 方法 采用回顾性病例系列研究分析2008年1月-2016年12月成都军区昆明总医院收治的69例四肢软组织缺损患者临床资料，其中男57例，女12例；年龄2-15岁，平均6．7岁。下肢创面56例，上肢创面13例。创面面积3 cm×4 cm-14 cm×15 cm，平均52．4 cm^2。均采用股前外侧皮瓣进行修复。记录皮瓣类型、穿支数量、穿支类型、供区伤口关闭情况、皮瓣术后愈合情况及并发症、再手术次数等。 结果69例患者共切取70块股前外侧皮瓣，其中肌皮瓣42块，穿支皮瓣28块。术中见76个穿支，其中肌间隔穿支14支，肌皮穿支62支。供区直接缝合52例，植皮18例。术后皮瓣危象4例，探查后部分坏死3例，完全成活1例。因感染皮瓣完全坏死1例，余皮瓣均成活。术后皮瓣边缘坏死6例，局部感染6例，伤口裂开3例。患者均获随访6—33个月，平均14．9个月。供区瘢瘢痕增生27例，术后再手术46次，其中行皮瓣修薄术23次，植皮7次，清创4次，其他12次。结论股前外侧皮瓣是修复儿童四肢创面安全可靠的方法，肌皮瓣是其主要应用形式。但儿童股前外侧皮瓣术后供区瘢瘢痕增生较多，且再手术率高。Objective To investigate the effect and characteristics of anterolateral thigh flap in repair of extremity wound in children. Methods A retrospective case series study was conducted to analyze the clinical data of 69 patients with limb soft tissue defects admitted to Kunming General Hospital of PLA from January 2008 to December 2016. There were 57 boys and 12 girls, aged 2-15 years （ mean, 6.7 years）. There were 56 cases of lower extremity wounds and 13 cases of upper limb wounds. The wound areas ranged from 3 cm ×4 cm to 14 cm × 15 cm, with an average of 52.4 cm2. All wounds were repaired with the anterolateral thigh flap. The type of flap, number of perforators, type of perforation, closure of donor site, healing of the flap, complications, and reoperation were recorded. Results Seventy anterolateral thigh flaps were harvested in 69 children, including 42 musculocutaneous flaps and 28 perforator flaps. Intraoperative visualization identified 76 perforators, including 14 septocutaneous and 62 musculocutaneous perforators. The donor site was closed primarily in 52 cases, and a split-thickness skin graft was required in 18 cases. After operation, vascular crisis occurred in four cases. After exploration, one flap survived, and partial necrosis was found in three flaps. Except for one flap with total necrosis because of infection, the rest of the flaps survived. Other postoperative complications included flap edge necrosis in six cases, local infection in six, and wound dehiscence in three. The follow-up ranged from 6 to 33 months, averaged 14. 9 months. Hypertrophic scar occurred at donor site in 27 children. The number of reoperation was 46, including 23 debulking procedures, seven skin grafts, four debridements, and 12 others. Conclusions The anterolateral thigh flap is a safe, reliable option for reconstruction of soft tissue defects in extremities of children. The anterolateral thigh musculocutaneous flap is used commonly in children. However, hypertrophic scar at donor site occurs more often after flap

关 键 词：外科皮瓣 软组织损伤 皮肤移植 儿童 

分 类 号：R726.5[医药卫生—儿科]