修薄股前外侧穿支皮瓣修复手背皮肤缺损  

Restrictive thin anterolateral thigh perforator flap for repairing dorsal hand skin defect

作　　者：游兴 张弛 孙广峰 吴必华 张天华 魏在荣 王达利 YOU Xing;ZHANG Chi;SUN Guangfeng(Department of Plastic Surgery,The Second Affiliated Hospital of Zunyi Medical University,Zunyi,Guizhou,563000,China)

机构地区：[1]遵义医科大学第二附属医院烧伤整形外科,贵州遵义563000 [2]遵义医科大学附属医院烧伤整形外科,贵州遵义563003

出　　处：《实用手外科杂志》2021年第2期142-144,共3页Journal of Practical Hand Surgery

基　　金：遵义医学院硕士科研启动基金资助项目(项目编号:F-914)。

摘　　要：目的探讨修薄的股前外侧穿支皮瓣修复手背部皮肤缺损的疗效。方法2010年1月-2019年1月,收治手背部皮肤软组织缺损22例,创面面积:4 cm×5 cm~7 cm×14 cm。采用修薄的股前外侧穿支皮瓣修复,借助便携式超声多普勒定位穿支血管,皮瓣面积:5 cm×6 cm~8 cm×15 cm,在阔筋膜上或下层切取股前外侧穿支皮瓣,穿支皮瓣切取成功后,皮瓣断蒂前给予限制性修薄,在细小脂肪粒层与粗大脂肪粒层之间修剪脂肪筋膜组织,保留真皮下血管网以及细小脂肪颗粒层,由周边至穿支点修薄,应用修薄后的股前外侧穿支皮瓣游离移植修复创面,供瓣区均直接缝合。术后常规“三抗”治疗,指导患者功能康复训练,随访观察。结果术后随访6~28个月,平均11个月。皮瓣全部成活,皮瓣不臃肿,外观满意。供瓣区一期愈合,对下肢行走无明显影响。结论修薄的股前外侧穿支皮瓣,在修薄的同时保留了皮瓣真皮下血管网,保护了皮瓣的有效血供,提高皮瓣成活率,而且无需再次手术整形,是修复手背部创面的理想方案之一。Objective To investigate the effect of restrictive thinning anterolateral thigh perforator flaps for repairing skin defect on opisthenar.Methods From January 2010 to January 2019,treated 22 cases of skin and soft tissue defect on the back of hand,Including 8 cases of traffic accident.Wound size ranged from 4 cm×5 cm to 7 cm×14 cm.Restrictive thinning of anterolateral thigh perforator flaps was used to repair all cases.Portable ultrasound Doppler was used to detect the location of blood vessels before operation.The size of the flap ranged from 5 cm×6 cm to 8 cm×15 cm.Excision of anterolateral thigh perforator flaps in the upper or lower layer of vagina femoris,after the cutting is completed,gradual thinning from periphery to vascular center before cutting off the vascular pedicle,retention of subdermal fat granules.Restrictive thinning of anterolateral thigh perforator flaps for wound repair,and direct suture of the donor site were made.postoperative anti-inflammation,anticoagulation and anti-spasm therapy,and guidance of functional exercise rehabilitation of patients,follow-up observation.Results Follow-up observation ranged from 6 to 28 months,with an average of 11 months.All flaps survived without bulky,and satisfactory appearance.The donor site healed well and had no significant influence on walking.Conclusion Restrictive thinning of anterolateral thigh perforator flaps is one of the ideal schemes for repairing dorsal hand wounds.It can be quickly cut and thinner flap,effectively preserve the subdermal vascular network of the flaps,ensure the effective blood supply of the flaps,improve the survival rate of the anterolateral thigh perforator flaps,and do not need reoperation.

关 键 词：股前外侧穿支皮瓣 外科皮瓣 创面修复 修薄术 

分 类 号：R658.2[医药卫生—外科学]