单叶或双叶带阔筋膜的股前外侧皮瓣在手足背皮肤肌腱缺损中的应用  

Clinical application of single or bilobed free anterolateral thigh flaps with fascia lata in repair of dorsal skin and tendon defects of hand and foot

作　　者：金光哲[1] 巨积辉[1] 熊胜[1] 唐林峰[1] 王凯[1] 王强[1] 侯瑞兴[1] Jin Guangzhe;Ju Jihui;Xiong Sheng;Tang Linfeng;Wang Kai;Wang Qiang;Hou Ruixing(Department of Hand Surgery, Ruihua Hospital Affiliated to Suzhou University, Suzhou 215104, China)

机构地区：[1]苏州大学附属瑞华医院手外科,苏州215104

出　　处：《中华手外科杂志》2019年第4期241-243,共3页Chinese Journal of Hand Surgery

基　　金：江苏省青年医学人才项目(QNRC2016223);江苏省333高层次人才资助项目(BRA2017068).

摘　　要：目的探讨单叶或双叶带阔筋膜的股前外侧皮瓣修复手足背皮肤肌腱缺损的临床疗效。方法自2014年1月至2018年3月,我们对18例手足背皮肤肌腱缺损患者,采用单叶或双叶带阔筋膜的股前外侧皮瓣修复。手背创面14例,足背创面4例。其中伴1条肌腱缺损1例,伴2条肌腱缺损5例,伴3条肌腱缺损8例,伴4条肌腱缺损3例,伴5条肌腱缺损1例。单叶修复12例,双叶修复6例。6例术后进行了二次皮瓣整形及肌腱松解术。结果术后18例皮瓣全部存活,伤口均I期愈合,大腿供区愈合良好,仅留有线性瘢痕,随访时间为6~24个月,平均13个月。14例手背缺损病例按中华医学会手外科学会上肢功能评定标准评定:优6例,良7例,差1例。4例足背缺损病例功能恢复良好,足趾无下垂,行走功能不受限。11例皮瓣外形、质地优良,无伸肌腱再次断裂及粘连。6例因皮瓣臃肿外形不满意,于术后3个月行二次手术修薄;其中4例手部创面修复术后伴有肌腱粘连,在皮瓣修薄的同时行肌腱松解术,术后外形及功能恢复满意。结论单叶或双叶带阔筋膜的股前外侧皮瓣修复手足背皮肤肌腱缺损对供区损伤小,手足功能恢复好,是修复此类损伤较理想的方法。Objective To explore the clinical efficacy of single or bilobed free anterolateral thigh flaps with fascia lata in repair of dorsal skin and tendon defects of hand and foot. Methods From January 2014 to March 2018, 18 patients with dorsal skin and tendon defects of hand and foot were repaired with single or bilobed free anterolateral thigh flaps with fascia lata, including 14 cases of dorsal hand wound and 4 cases of dorsal foot wound. Among them, 1 case was accompanied with 1 tendon defect, 5 cases with 2 tendon defects, 8 cases with 3 tendon defects, 3 cases with 4 tendon defects, and 1 case with 5 tendon defects. There were 12 cases of single lobed flaps and 6 cases of bilobed flaps. 6 cases underwent secondary flap plastic surgery and tenolysis after operation. Results All the 18 flaps survived and the wound achieved primary healing. The donor site of thigh healed well with only linear scar. The follow-up period was 6 to 24 months with an average of 13 months. 14 cases of dorsal skin defects in hand were evaluated according to the criteria issued by the Hand Surgery Society of the Chinese Medical Association with the results being excellent in 6 cases, good in 7 cases, poor in 1 case. 4 cases of dorsal skin defects in foot had good functional recovery, no toe droop and no limitation of walking function. The appearance and texture of the flaps were excellent in 11 cases. No rerupture or adhesion of extensor tendon occurred. 6 cases underwent second operation to thin the skin flaps 3 months after operation because of unsatisfactory shape. 4 of them had tendon adhesion after hand wound repair. The tenolysis was performed at the same time of skin flaps thinning. The appearance and function of the flaps recovered satisfactorily. Conclusion The single or bilobed free anterolateral thigh flaps with fascia lata in repair of dorsal skin and tendon defects of hand and foot have little damage to donor site. It is an ideal method for repairing such injuries for good recovery of hand and foot function.

关 键 词：外科皮瓣 治疗结果 阔筋膜 皮肤缺损 肌腱缺损 

分 类 号：R658[医药卫生—外科学]