双叶股前外侧皮瓣移植修复足踝部复杂创面  

Repair of complex foot and ankle wounds with bilateral anterolateral thigh flaps

作　　者：周荣[1] 巨积辉[1] 杨亮 刘跃飞[1] 侯瑞兴[1] Zhou Rong;Ju Jihui;Yang Liang;Liu Yuefei;Hou Ruixing(Department of Foot and Ankle Surgery,Ruihua Affiliated Hospital of Soochow University,Suzhou 215104,China)

机构地区：[1]苏州大学附属瑞华医院足踝外科,215104

出　　处：《中华整形外科杂志》2019年第8期779-784,共6页Chinese Journal of Plastic Surgery

基　　金：江苏省自然科学基金(BK20151203);江苏省青年医学人才项目(QNRC2016224);江苏省333工程资助项目(BRA2017068)

摘　　要：目的探讨双叶股前外侧皮瓣修复足踝部复杂创面的临床效果。方法2014年4月至2017年6月,苏州大学附属瑞华医院收治16例足踝部复杂创面患者,男15例,女1例,年龄12~73岁。其中2例为2处创面存留,创面面积4 cm×5 cm^6 cm×10 cm。14例为单个创面存留,创面面积11 cm×8 cm^42 cm×15 cm。根据创面设计布样,将宽大创面的布样拆分成宽度均小于8 cm的2块布样,以大腿外侧髂-髌连线上B超定位的皮瓣穿支点为轴点设计双叶股前外侧皮瓣,并通过DSA影像观察皮瓣皮肤穿支源动脉走行,若双叶皮瓣皮肤穿支为共干源动脉,则直接切取游离后修复相邻两创面或拼接后修复单个宽大创面;若双叶皮瓣皮肤穿支非共干源动脉,则对双叶皮瓣分别进行切取,断蒂后将高位穿支皮瓣内穿支血管与低位穿支皮瓣内旋股外侧动脉远端断端进行吻合,形成新的并联双叶皮瓣,再进行拼合或分叶移至受区。皮瓣供区均直接缝合。结果采用以双穿支共干的并联双叶股前外侧皮瓣修复11例,采用吻合桥接穿支血管形成新的并联的股前外侧双叶皮瓣修复5例。皮瓣切取面积5 cm×6 cm^8 cm×22 cm。术后16例皮瓣全部存活,供区伤口均一期愈合。5例因皮瓣外形臃肿于术后6~10个月行内固定取出和皮瓣修薄术。术后随访6~18个月,皮瓣色泽、质地良好,皮瓣感觉S1~S3。供区均遗留线性瘢痕,下肢活动正常。结论采用双叶股前外侧皮瓣修复足踝部复杂创面,具有设计灵活,皮瓣血运好、供区损伤小等优点,是一种较好的方法。Objective To explore the clinical effect of bilateral anterolateral thigh flaps in repairing complex wounds of foot and ankle.Methods From April 2014 to June 2017,16 patients with complex foot and ankle wounds were treated in Ruihua Hospital Affiliated to Soochow University.There were 15 males and 1 female,aged from 12 to 73 years.Two of them had two wounds for each,the area of which was from 4 cm×5 cm to 6 cm×10 cm.Fourteen cases were single-wounds,the area of which ranged from 11 cm×8 cm to 42 cm×15 cm.According to the wound surfaces,the wide wound cloth was divided into two pieces of cloth with a width less than 8 cm.The double-leaf skin flap was designed at the point of the perforating branch of the skin flap located by B-ultrasound on the iliac-patellar connecting line of the donor area.The course of the origin artery of the skin perforating branch of the skin flap was observed by DSA image.If the perforating branch of the double-leaf skin flaps was the common origin artery,the two adjacent wounds would be repaired directly.If the perforator of the double-leaf skin flaps is not the common artery,the double-leaf skin flaps were cut separately.After the pedicle division,the perforator vessels of the high perforator skin flaps were anastomosed with the distal end of the medial circumflex lateral femoral artery of the low perforator skin flaps to form a new parallel double-leaf skin flaps,which were then assembled or lobed to the recipient area.Flap donor sites were sutured directly.Results 11 cases were repaired with parallel bilateral anterolateral thigh flaps with double perforators,and 5 cases were repaired with new parallel bilateral thigh flaps formed by anastomotic bridging of perforator vessels.The area of the flaps ranged from 5 cm×6 cm to 8 cm×22 cm.All the 16 flaps survived and the donor site wounds healed in one stage.Five cases underwent internal fixation removal and skin flap thinning 6 to 10 months after operation.Follow-up for 6 to 18 months showed that the skin flaps were of good color and

关 键 词：外科皮瓣 股前外侧皮瓣 踝 足 创面 供区 

分 类 号：R65[医药卫生—外科学]