削薄股前外侧皮瓣在儿童足踝部软组织缺损中的应用  

Clinical application of thin anterolateral thigh flap in the treatment of soft tissue defect of foot and ankle in children

作　　者：古欣庆 周洋 朱红亮 李孝根 黄东 GU Xinqing;ZHOU Yang;ZHU Hongliang(Department of Surgery,Heping Orthopedic Hospital,Guangzhou,Guangdong,510317,China)

机构地区：[1]广州和平骨科医院手外三科,广东广州510317

出　　处：《实用手外科杂志》2021年第2期173-176,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨应用削薄股前外侧皮瓣修复儿童足踝部皮肤软组织缺损的临床疗效。方法2017年10月-2019年12月,采用削薄股前外侧皮瓣游离移植修复儿童足踝部皮肤软组织缺损16例,缺损面积:3.0 cm×5.5 cm~6.0 cm×18.0 cm,均伴有肌腱、韧带及骨质外露。术前采用超声多普勒探测仪确定穿支点并标记,切取股前外侧皮瓣面积:4.0 cm×7.0 cm~7.0 cm×20.0 cm,供区采用皮下减张缝合,皮肤采用美容缝合,不能直接缝合采用腹股沟游离中厚或全厚皮片植皮修复。术后定期门诊随访,评估皮瓣外观、质地,足踝部功能及供区恢复情况。结果16例患儿出院后均建立门诊随访或微信照片视频资料收集记录,随访2~15个月,平均8个月。术后皮瓣全部成活,愈合时间12~20 d,供区10例直接缝合,6例植皮皮肤成活良好。在治疗过程中其中1例患儿因疼痛哭闹、肢体移动发生动脉痉挛;1例皮瓣因血肿卡压静脉回流障碍,给予及时换药拆线及静脉使用罂粟碱、镇痛泵后缓解;1例皮瓣远端小部分坏死,经换药处理后,创面愈合良好。术后皮瓣颜色与周围皮肤接近,质地较为柔软,3例患儿足背及踝关节部位有少许臃肿,二期取内固定给予削薄脂肪组织,2例二期行异体肌腱移植修复趾伸肌腱,随访负重行走良好,无瘢痕畸形,无足部溃疡等并发症,踝关节及足部屈伸功能恢复良好,日常穿鞋行走无影响。结论采用削薄股前外侧皮瓣游离移植修复儿童足踝部皮肤软组织缺损,效果良好,是临床较为理想修复方法之一。Objective To investigate the clinical effect of thin anterolateral femoral flap in children with soft tissue defect of foot and ankle.Methods From October 2017 to December 2019,16 children with soft tissue defects of foot and ankle were repaired by thin free anterolateral femoral flap,covering an area of 3.0 cm×5.5 cm~6.0 cm×18.0 cm,all of them were accompanied by tendon,ligament and bone exposure.The puncture point and mark were determined by ultrasonic Doppler detector before operation.The area of the anterior femoral skin flap was 4.0 cm×7.0 cm~7.0 cm×20.0 cm,the donor skin was treated with cosmetic suture,and the free and full thickness skin graft of groin for no directly suturing.The appearance,texture,function of ankle and the recovery of donor area were evaluated.Results Sixteen children were followed up in the hospital.The follow-up or wechat photo video data were collected and recorded after discharge.The follow-up was 2~15 months,with an average of about 8 months.The flap survived for 12~20 days,10 cases were sutured directly in the donor area and 6 cases were well preserved.In the course of treatment,one case suffered from pain and crying,arterial spasm occurred in limb movement;one case of flap was blocked by hematoma and blocked venous reflux,and was relieved after timely drug removal and intravenous use of papaverine and analgesic pump;One case of flap was necrosis in the distal part,after the treatment of the change of medicine,the wound healed well.The skin flap was close to the surrounding skin and soft in texture.There were a little bloated and fixed in 3 children with fat tissue.In the second stage,2 cases were treated with allogeneic tendon transplantation to repair the extensor digitorum tendon.The follow-up was good,no scar deformity,foot ulcer and other complications.The ankle joint and foot flexion and extension function recovered well,Daily shoes walking had no effect.Conclusion The thin free anterolateral femoral flap is one of the ideal methods for the treatment of soft tissue defec

关 键 词：股前外侧皮瓣 削薄 足踝部 儿童 显微外科技术 

分 类 号：R726.5[医药卫生—儿科]