股前外侧分叶皮瓣术中未能切取与中转方案  

Failing to harvest two-paddle anterolateral thigh flap and converting algorithm

作　　者：何晓清[1] 杨曦[1] 段家章 李国栋[1] 崔轶[1] 徐月仙[1] 王腾[1] 徐永清[1] He Xiaoqing;Yang Xi;Duan Jiazhang;Li Guodong;Cui Yi;Xu Yuexian;Wang Teng;Xu Yongqing(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：《中华显微外科杂志》2018年第5期437-440,共4页Chinese Journal of Microsurgery

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

摘　　要：目的探讨股前外侧分叶皮瓣术中未能按术前计划切取时的应对措施及中转方案。方法回顾2009年1月至2015年12月期间应用股前外侧分叶皮瓣47例中不能正常切取的8例患者临床资料。其中男7例，女1例；年龄16~48岁，平均32.8岁。6例为单一创面，2例为2个相邻创面；创面面积：60~247 cm^2。记录皮瓣穿支血管数量、来源、皮瓣切取形式及愈合情况。所有患者均定期随访。结果8例患者均成功完成术中中转。4例因供区只有1条穿支血管，术中转为增宽的单穿支皮瓣加供区植皮；2例因2条穿支血管来源不同，中转为串联皮瓣；1例因2条穿支分别起源于旋股外侧动脉横支和降支，中转为横支-降支联合皮瓣，1例为贯通伤创面引起的一大、一小创面，中转为去表皮的单穿支分叶皮瓣。皮瓣面积：78~288 cm^2。术后1例发生静脉危象，探查后成活；局部感染2例，换药后好转；余皮瓣平稳成活。供区伤口裂开1例，感染1例，均行清创缝合术。术后随访7~21个月，平均11.5个月，皮瓣色泽良好、质地柔软。结论股前外侧分叶皮瓣切取困难时，需要根据创面特点、穿支数量及血管来源等因素，选择合理的中转方案。ObjectiveTo explore how to overcome the difficulties during two paddle anterolateral thigh flap harvest.MethodsFrom January, 2009 to December, 2015, the harvest of two paddle anterolateral thigh flap was encountered difficulties during surgery in 8 cases, which were 7 males and 1 female. The age was ranged from 16 to 48 years old, with averaged of 32.8. Six patients presented with one defect, and 2 patients presented with two defects. The skin defects ranged from 60-247 cm^2. The number of the flap perforator, vascular source, flap pattern and outcomes was recorded. All patiants were followed-up at regular intervals.ResultsAll of 8 flaps were converted successfully during surgery. Only 1 perforator was found in 4 cases. The flap was converted to sigle perforator flap. The dornor site was covered by skin graft. Two perforators from different origins were found in 2 cases, and the flap was converted to sequential chimeric flap. Two perforators from descending branch and transverse branch respectively were found in 1 case, and the flap was converted to combined anterolateral thigh and tensor fascia lata flap. Only 1 perforator was found in 1 case, which the distal defect was small sized, the flap was converted to deepithelialized two paddle flap. The flap ranged from 78-288 cm^2. Venous compromise was happened in 1 case, and the flap survived after reexploration surgery. Local infection was found in 2 cases, and cured with wound dressing. Other flaps were survived uneventfully. At donor site, 1 case wound dehiscence and 1 case local infection, both of which underwent debridement and healed. All patiants were followed-up for 7-21（mean, 11.5）months. The flaps had satisfactory appearance and soft texture.ConclusionWhen it is difficult to harvest two paddle anterolateral thigh flap during surgery, the flap need to be converted rationally based on the characteristics of the defect, the number of the flap perforator, and the vascular origins.

关 键 词：分叶皮瓣 穿支皮瓣 股前外侧皮瓣 四肢 移植 显微外科技术 

分 类 号：R687.3[医药卫生—骨科学]