游离股前外侧穿支皮瓣与一期功能重建修复前臂背侧复合组织缺损  

Free anterolateral thigh perforator flap with one-stage functional reconstruction for repair of composite tissue defects of dorsal forearm

作　　者：李祥军[1] 巨积辉[1] 李明伟 邹坤 Li Xiangjun;Ju Jihui;Li Mingwei;Zou Kun(Department of Hand Surgery,Ruihua Hospital Affiliated to Suzhou University,Jiangsu 215104,China)

机构地区：[1]苏州大学附属瑞华医院手外科,江苏215104

出　　处：《中华手外科杂志》2020年第3期174-176,共3页Chinese Journal of Hand Surgery

基　　金：江苏省青年医学人才项目(QNRC2016224);苏州市科教兴卫-青年科技项目(KJXW2016069)。

摘　　要：目的探讨应用游离股前外侧穿支皮瓣与一期功能重建修复前臂背侧复合组织缺损的临床疗效。方法自2015年1月至2018年12月我们收治3例前臂背侧皮肤软组织缺损合并伸肌(腱)缺损患者,游离股前外侧穿支皮瓣移植覆盖前臂背侧创面,同时一期肌腱转位重建2~5指伸指功能。结果术后3例皮瓣全部存活,未发生血管危象。切口均Ⅰ期愈合。术后随访4~24个月,平均13个月。皮瓣外形良好,皮瓣的色泽、质地良好,接近前臂背侧皮肤,皮瓣供区愈合良好,植皮区无破溃。患指掌指关节可以完全伸直,肌力恢复至M4。随访4个月的患者2~5指掌指关节主动活动度为0°~70°,其余2例患者为0°~90°,3例患者的远近指间关节主动活动均正常,按中华医学会手外科学会上肢部分功能评定试用标准评定:良3例。结论应用游离股前外侧穿支皮瓣与一期功能重建是修复前臂背侧复合组织缺损的理想方法。Objective To explore the clinical efficacy of free anterolateral thigh perforator flap with one-stage functional reconstruction for repair of composite tissue defects of dorsal forearm.Methods From January 2015 to December 2018, 3 cases with skin and soft tissue defects of dorsal forearm combined with extensor (tendon) defects were treated. The free anterolateral thigh perforator flap was used to cover the dorsal wound of forearm, and the function of the second to fifth finger extension was reconstructed by one-stage tendon transposition.Results All the flaps survived without vascular crisis. All the incisions achieved primary healing. The postoperative follow-up period ranged from 4 to 24 months with an average of 13 months. The appearance of the flap was good as well as its color and texture, which was similar to the normal skin of dorsal forearm. The flap donor site healed well and no ulceration occurred in the area of skin graft. The metacarpophalangeal joint of the affected finger could be fully extended and the muscle strength restored to M4. The active range of motion of the metacarpophalangeal joint was 0° to 70° in the patients followed up for 4 months, and 0° to 90° in the other 2 patients. The active range of motion of the interphalangeal joint was normal in 3 patients. According to the evaluation criteria of upper limb function of Hand Surgery Society of Chinese Medical Association, the results were good in 3 patients.Conclusion It is an ideal method to use the free anterolateral thigh perforator flap with one-stage functional reconstruction to repair the composite tissue defects of dorsal forearm.

关 键 词：前臂损伤 外科皮瓣 穿支 功能重建 

分 类 号：R658.2[医药卫生—外科学]