股前外侧穿支皮瓣与腹壁下动脉穿支皮瓣修复大面积下肢软组织缺损的疗效比较  

Comparative study of anterolateral thigh perforator flap and deep inferior epigastric perforator flap in repairing large area soft tissue defects of lower limbs

作　　者：刘东 欧昌良 周鑫 邹永根 罗琳 伍光辉 Liu Dong;Ou Changliang;Zhou xin;Zou Yonggen;Luo Lin;Wu Guanghui(Microsurgery Repair and Reconstruction Center,Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University,Luzhou,Sichuan 646000,China)

机构地区：[1]西南医科大学附属中医医院显微外科修复重建中心,四川泸州646000

出　　处：《创伤外科杂志》2021年第6期412-416,共5页Journal of Traumatic Surgery

基　　金：四川省科技厅项目基金(14ZC0026)。

摘　　要：目的比较股前外侧穿支皮瓣(ALTP)与腹壁下动脉穿支皮瓣(DIEP)修复大面积下肢软组织缺损的差异。方法回顾性分析2016年6月—2019年2月西南医科大学附属中医医院显微修复重建外科中心收治的皮瓣修复大面积下肢软组织缺损的患者33例,男性24例,女性9例;年龄22~57岁,平均39.6岁。道路交通伤20例,机器挤压伤9例,热压伤3例,电烧伤1例;足踝部4例,小腿23例,大腿6例;软组织缺损面积15cm×7cm~29cm×15cm,创面均伴血管、肌腱外露,其中合并骨折13例;入院后即予以VSD负压吸引装置覆盖创面,约1周创面清洁后行皮瓣修复。根据治疗方式不同分为股前外侧穿支皮瓣(ALTP)组18例和腹壁下动脉穿支皮瓣(DIEP)组15例,随访时间9~24个月,平均12.1个月。比较两组患者皮瓣成活率、Ⅰ期愈合率、皮瓣面积、制备时间、皮瓣保护性感觉恢复、皮瓣并发症、供区优良率的差异。结果患者均顺利完成手术,两组患者皮瓣均成活。两组患者皮瓣面积、制备时间差异、Ⅰ期愈合率、保护性感觉恢复(161.7±16.6)cm^(2) vs.(171.2±14.7)cm^(2)、(83.7±12.8)min vs.(92.3±20.2)min、90.5%vs.94.1%、12例vs.7例,差异无统计学意义(P>0.05)。ALTP组皮瓣边缘部分坏死2例,经植皮后皮瓣成活,其余皮瓣均Ⅰ期成活。DIEP组皮瓣边缘部分坏死1例,经换药后皮瓣成活,其余皮瓣均Ⅰ期成活;皮瓣臃肿2例,愈合后行修薄处理,两组皮瓣并发症比较差异无统计学意义(P=0.639)。ALTP组供区优良率为61.1%(11/18),DIEP组供区优良率93.3%(14/15),差异有统计学意义(P=0.046)。结论ALTP与DIEP在修复大面积下肢软组织缺损时均有较高成功率,DIEP供区术后能达到美学要求,患者满意度更高,选择何种皮瓣应根据患者的自身条件及修复目的灵活性而定。Objective To evaluate the clinical results of the anterolateral thigh perforator flap and deep inferior epigastric perforator flap in repairing large area soft tissue defects of lower limbs.Methods From Jun.2016 to Feb.2019,33 cases of skin flap repairing large area of lower limb soft tissue defects were analyzed retrospectively,including 24 males and 9 females,with an average age of 39.6 years(range,22-57 years).There were 20 cases of road traffic injury,9 cases of machine crush injury,3 cases of hot crush injury and 1 case of electric burn;there were 4 cases of foot and ankle,23 cases of calf,and 6 cases of thigh;soft tissue defect area:15cm×7cm-29cm×15cm.All wounds were accompanied by vascular and tendon exposure,including 13 cases with fracture.After admission,the wound was covered with VSD negative pressure suction device.About one week after the wound was cleaned,the skin flap was repaired.They were divided into anterolateral thigh perforator flap(ALTP)group(n=18)and deep inferior epigastric perforator flap(DIEP)group(n=15)according to different treatment methods.The mean follow-up time was 12.1 months(range,9-24 months).The flap survival rate,primary healing rate,flap area,preparation time,flap protective sensory recovery,flap complications and donor site excellent and good rate were compared between the two groups.Results All patients successfully completed the operation,and the flaps of both groups survived.There was no significant difference in flap area,preparation time,primary healing rate or protective sensory recovery between the two groups[(161.7±16.6)cm^(2) vs.(171.2±14.7)cm^(2),(83.7±12.8)minutes vs.(92.3±20.2)minutes,90.5%vs.94.1%,12 cases vs.7 cases,P>0.05].In the ALTP group,2 cases of flaps necrosis at the edge of the flap survived after skin grafting,and the remaining flaps survived in the first stage.In the DIEP group,one flap was partially necrotic and survived after dressing change,the other flaps survived in the first stage,and two flaps were thinned after healing due to flap overst

关 键 词：软组织损伤 下肢 穿支皮瓣 股前外侧 腹壁下动脉 

分 类 号：R683.42[医药卫生—骨科学]