游离股前外侧单穿支分叶皮瓣修复四肢大面积软组织缺损  

Reconstruction of large soft tissue defects of extremities with free polyfoliate anterolateral thigh perforator flaps based on a single perforator

作　　者：倪晓[1] 邱海胜[1] 张怀保[1] 王健[1] NI Xiao;QIU Haisheng;ZHANG Huaibao;WANG Jian(Department of Hand Surgery,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang Province 325000,China)

机构地区：[1]温州医科大学附属第一医院,浙江温州325000

出　　处：《中华显微外科杂志》2021年第3期283-286,共4页Chinese Journal of Microsurgery

基　　金：温州市科学技术局公益性科技计划项目(Y20150235)。

摘　　要：目的探讨游离股前外侧单穿支分叶皮瓣在修复四肢大面积软组织缺损中的应用效果。方法2014年3月至2019年4月,采用游离股前外侧单穿支分叶皮瓣修复四肢大面积软组织缺损9例共10块皮瓣。修复部位:手部及腕部6例,前臂1例,小腿1例,足部1例。四肢软组织缺损面积5 cm×19 cm-17 cm×24 cm,供区创面均一期缝合。术后通过门诊随访。结果本组7例患者皮瓣顺利成活;1例双游离皮瓣患者其中一块皮瓣术后发生动脉危象,急诊手术探查、吻合血管进行外增压后顺利成活;l例患者皮瓣的一个分叶坏死,经二期植皮修复残留创面。术后随访3-48个月,患者对皮瓣外观均较为满意,供区瘢痕略有挛缩。结论游离股前外侧单穿支分叶皮瓣可以在仅有单一穿支的情况下,对皮瓣进行分叶设计,通过皮瓣各叶间的不同组合,修复四肢大面积创面,供区创伤小,成活率高。Objective To evaluate the clinical results of using the free polyfoliate anterolateral thigh perforator flaps based on a single perforator in repair large soft tissue defects in extremities.Methods Between March,2014 and April,2019,9 patients with large soft tissue defects in extremities were repaired with the free polyfoliate anterolateral thigh perforator flaps based on a single perforator.One of the patients were repaired with bilateral free polyfoliate anterolateral thigh perforator flaps.Six defects on hand and wrist,1 on forearm,1 on shank and 1 on foot.The sizes of soft tissue defect ranged 5 cm×19 cm-17 cm×24 cm.All the wounds of donor site were closed primarily.Results Seven flaps survived without vascular incidence.One flap developed artery crisis after surgery with the bilateral free polyfoliate anterolateral thigh perforator flaps.After emergency re-anastomosing,the flap survived successfully.Necrosis on one-leaf occurred in one flap,which was finally repaired by skin graft.The clinical results were satisfactory after 3-48 months of followed-up.The scars of the donor site were not obvious.Conclusion The free polyfoliate anterolateral thigh perforator flaps can be designed with only one perforator.The flap can be changed into a variety of shapes based on the combination of the polyfoliate flaps in order to repair a large soft tissue defects in extremity.The polyfoliate flap has advantages of less donor site injury with a high survival rate.

关 键 词：股前外侧分叶穿支皮瓣 四肢 修复 显微外科技术 

分 类 号：R658[医药卫生—外科学]