带感觉神经的薄型股前外侧穿支皮瓣修复足背创面  

Repair of wound on dorsum of foot with thin anterolateral thigh perforator flap with sensory nerve

作　　者：吴迎 王先成 熊祥 孙杨 宋姮玥 Wu Ying;Wang Xiancheng;Xiong Xiang;Sun Yang;Song Hengyue(Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]湘雅二医院整形外科,长沙410011

出　　处：《中华整形外科杂志》2018年第10期848-852,共5页Chinese Journal of Plastic Surgery

摘　　要：目的探讨带感觉神经的薄型股前外侧穿支皮瓣修复足背软组织缺损的方法和临床效果。方法2012年1月至2017年2月收治14例足背软组织缺损患者，根据受区创面缺损的三维结构设计股前外侧穿支皮瓣，携带股外侧皮神经，在显微镜下行精细修薄后游离移植修复足背软组织缺损，皮瓣切取面积6 cm×4 cm～15 cm×9 cm，10例供区创面宽度≤8 cm可直接拉拢缝合，4例供区创面宽度〉8 cm，行皮片移植。结果术后14例皮瓣全部成活，其中1例皮瓣因局部感染远端出现部分表浅坏死，通过换药后愈合。术后均获随访，时间为6～24个月，皮瓣外形无臃肿、质地、色泽及弹性良好，部分皮瓣两点辨距觉达6～10 mm，感觉恢复达S2～S3级，患者能正常穿鞋行走，皮瓣无溃疡发生，供区创面愈合良好。结论应用带感觉神经的薄型股前外侧穿支皮瓣修复足背软组织缺损，安全可靠，外观良好，可以恢复部分感觉。Objective To investigate the treatment and clinical effect of thin anterolateral thigh perforator flap with sensory nerve in the repair of soft tissue defect of dorsal foot.Methods During January 2012 to February 2017, 14 cases of soft tissue defect of dorsalis pedis were treated. The flap was designed according to the three-dimensional structure of the defect in the recipient area, and the lateral femoral cutaneous nerve was carried. Free transplantation was performed for repair of soft tissue defect of dorsal foot after fine thinning under microscope. The selected size of the flap ranged from 6 cm×4 cm to 15 cm×9 cm, 10 cases of donor site width is less than or equal to 8 cm with direct suture, 4 cases of donor site wound greater than 8 cm, Free skin graft on the wound surface.Results After operation, all flaps survived. Meanwhile, superficial necrosis occurred in the distal part of the flap in 1 case due to local infection, and healed after dressing change. All patients were followed up for 6-24 months, the appearance of the flap was pleasant, the texture, color and elasticity of the flap were satisfactory. In addition, Partial skin flap two-point discrimination was 6-10 mm with S2, S3 sensory recovery. During the follow-up, patients were able to walk with normal shoes, no ulcer occurred in the flap, and healed well in donor site.Conclusions The application of thin anterolateral thigh perforator flap with sensory nerve is safe and reliable in the repair of soft tissue defect of dorsal foot. After the repair, the skin flap has a good appearance and can restore part of the sensation.

关 键 词：穿支皮瓣 股外侧皮神经 皮瓣修薄术 足背 

分 类 号：R658.3[医药卫生—外科学]