CTA辅助联合皮瓣修复小腿和足部大范围软组织缺损  

Repairing massive soft tissue defects of shank and foot with combined flaps with the help of 3D-CTA technique

作　　者：田振欣 窦金兰[1] 张晓丽[1] 窦洪磊[1] 刘兴龙[2] Tian Zhenxin;Dou Jinlan;Zhang Xiaoli;Dou Honglei;Liu Xinglong(Department of Hand and Foot Surgery,The Yidu Central Hospital of Weifang,Weifang,Shangdong Province 262500,China;Department of Traumatic Orthopedics,The Affiliated Hospital of Weifang,Weifang Medical College,Weifang,Shangdong Province 261000,China)

机构地区：[1]山东省潍坊市益都中心医院手足外科,262500 [2]山东省潍坊市潍坊医学院附属医院创伤骨科,261000

出　　处：《中华显微外科杂志》2019年第5期438-441,共4页Chinese Journal of Microsurgery

摘　　要：目的探讨三维重建CT血管造影(3D-CTA)技术辅助下采用联合皮瓣修复小腿和足部大范围软组织缺损的应用价值及手术技巧。方法2011年3月至2018年5月,采用联合皮瓣移植修复7例小腿和足部大范围软组织缺损,软组织缺损面积21 cm×14 cm^53 cm×16 cm。术前行3D-CTA检查明确血管分布和交通支吻合情况,根据结果设计皮瓣,其中采用腓肠神经营养血管局部转移皮瓣联合ALTP修复2例,采用内或外踝上穿支局部转移皮瓣联合ALTP修复2例,采用腓肠肌局部转移皮瓣联合胸脐皮瓣修复1例,采用胸脐皮瓣联合ALTP修复1例,采用游离胸脐皮瓣和ALTP桥接健侧胫后血管的交腿皮瓣修复l例。术后定期随访。结果患者均获得随访,采用门诊结合电话随访方式,时间6~18个月。皮瓣全部成活,皮瓣外观、颜色、质地均恢复较好。术后1年,根据Thermann量表功能评价:优4例,良2例,可1例。结论联合皮瓣为小腿和足部大范围软组织缺损的修复提供了切实可行的治疗方案,虽然存在一定风险,但是致残率明显降低,肢体功能基本恢复,治疗时间缩短。术前行3D-CTA检查明确了供、受区血管解剖结构,指导手术方案设计及实施,缩短了手术时间,提高了术中血管吻合准确率。Objective To explore the clinical value of repairing massive soft tissue defects of shank and foot with diverse combined flaps with the help of 3D-CTA technique.Methods From March,2011 to May,2018,7 patients with massive soft tissue defects(defect area:21 cm×14 cm-53 cm×16 cm)of shank and foot were treated with combined flaps,including free anterolateral thigh flaps(ALTP)combined with local transferred sural neurocutaneous vascular flaps in 2 cases,free ALTP combined with local transferred supracondylar flap in 2 cases,free thoraco-umbilical flaps plus local transferred gastrocnemius muscular flaps in 1 case,and free ALTP plus free thoraco-umbilical flap in 1 case.Free ALTP and free thoraco-umbilical flap respectively combined with double bridge flaps using the both ends of posterior tibial vessel from the healthy limb to form vascular pedicles in 1 case.All cases received 3D-CTA to observe the distribution and anastomosis of perforator vessel.Regular followed-up was made post-operatively.Results All patients had been followed-up for 6-18 months.Outpatient service combined with telephone follow-up was adopted.All flaps survived,and flap shape,colour and lustre,elasticity got good recover.At the last follow-up,thermann scale function assessment:4 cases were excellent,2 were good,and 1 was fair.Conclusion It is a feasible and effective method to repair massive soft tissue defects of shank and foot using differently combined flaps.Although the surgery can be risky,the method can effectively reduce the rate of limb disability,restore the limb function and shorten the course of treatment.Preoperative 3D-CTA can get the vessel anatomical structure and diameter at donor and recipient sites,which will guide the operation program design and implementation so as to shorten the operation time and improve the accuracy rate of vascular anastomosis.

关 键 词：三维重建CT血管造影 联合皮瓣 股前外侧穿支皮瓣 小腿损伤 足损伤 修复 

分 类 号：R65[医药卫生—外科学]