Flow-through股前外侧穿支皮瓣在断肢再植创面修复中的应用  

Flow-through anterolateral thigh perforator flap in repair of the wound after limb replantation

作　　者：王强[1] 巨积辉[1] 刘杰 吕文涛[1] 金光哲[1] WANG Qiang;JU Jihui;LIU Jie;LYU Wentao;JIN Guangzhe(Department of Hand Surgery,Ruihua Affiliated Hospital of Soochow University,Suzhou,Jiangsu Province 215104,China)

机构地区：[1]苏州大学附属瑞华医院手外科,江苏苏州215104

出　　处：《中华显微外科杂志》2020年第6期540-543,共4页Chinese Journal of Microsurgery

基　　金：江苏省青年医学重点人才项目(QNRC2016221)。

摘　　要：目的探讨Flow-through股前外侧穿支皮瓣(ALTP)在断肢再植创面修复中的临床应用及效果。方法2016年8月至2018年8月,利用Flow-through ALTP修复断肢再植后遗留创面共9例,急诊修复3例,择期修复6例。其中前臂离断创面2例,肘部离断创面1例,踝部离断创面3例,小腿离断创面3例,创面内均有肌腱与骨质外露。软组织缺损大小13.0 cm×7.0 cm^25.0 cm×12.0 cm,血管缺损长度6.0~10.0 cm。术后观察再植肢体及皮瓣成活情况,对皮瓣外形及感觉、桥接血管通畅性、再植肢体功能及供区外形功能恢复情况定期随访。结果本组9例再植肢体及皮瓣全部成活。术后随访6~24个月,平均12个月,再植肢体及皮瓣血运良好,CDU探查桥接血管血流通畅。皮瓣质地良好,2例外形稍臃肿,7例外形满意;3例无感觉恢复,6例恢复保护性感觉。供区遗留线形瘢痕,下肢功能正常。根据陈中伟断肢再植评定标准,良5例,可3例,差1例。结论利用Flow-through ALTP修复断肢再植后的遗留创面,保留肢体完整性,恢复肢体外形,同时供区损伤小,是一种理想修复方法。Objective To explore the clinical application and effect of Flow-through anterolateral thigh perforator flap(ALTP)in repair of the traumatic wound after limb replantation.Methods From August,2016 to August,2018,9 cases of traumatic wounds after limb replantation were treated by Flow-through ALTP.Among the cases,3 were treated in emergency and 6 were treated in second stage.Two cases had the traumatic wound at forearm,1 at the elbow,3 at the ankle,and 3 at the shank.All the traumatic wounds had tendons and bone exposed.The areas of traumatic wound was 13.0 cm×7.0 cm to 25.0 cm×12.0 cm.The length of vascular defect was from 6.0 cm to 10.0 cm.Postoperative survival of the replanted limbs and flaps was observed.Shape and sensation of flaps,patency of bridging vessels,function of replanted limbs,as well as the shape and function of donor sites were reviewed during the regular followed-up.Results All the replanted limbs and flaps survived.The followed-up period was 6 to 24 months in an average of 12 months.Blood supplies of the replanted limbs and the flaps were good,the Flow-through artery was unobstructed and the texture of the flap was satisfactory.The flap appearance was satisfactory in 7 cases and the others were slightly bulky.Protective sensation of the flaps was recovered in 6 cases and failed in others.Linear scars were left at all donor sites and the function of lower limbs was normal.According to Chen's evaluation criteria for replantation of amputated limbs,there were good in 5 cases,fair in 3 cases and poor in 1 case.Conclusion It is an ideal method to use Flow-through ALTP to repair the traumatic wound after replantation of amputated limb.It could preserve the limb integrity and restore limb appearance with little morbidity of donor site.

关 键 词：股前外侧穿支皮瓣 血流桥接皮瓣 断肢再植 创面修复 

分 类 号：R658.1[医药卫生—外科学]