多穿支超长股前外侧皮瓣修复足踝部环形创面  

Application of multiple-perforator extra-large anterolateral thigh flap for repairing of circular wound of foot and ankle

作　　者：周荣[1] 巨积辉[1] 柳志锦 刘胜哲 郭礼平[1] 刘跃飞[1] 胡昌庆[1] 杨亮 Zhou Rong;Ju Jihui;Liu Zhijin;Liu Shengzhe;Guo Liping;Liu Yuefei;Hu Changqing;Yang Liang(Department of Foot and Ankle Surgery,Ruihua Hospital of Soochow University,Suzhou 215104,China)

机构地区：[1]苏州大学附属瑞华医院足踝外科,215104

出　　处：《中华整形外科杂志》2021年第11期1244-1250,共7页Chinese Journal of Plastic Surgery

基　　金：江苏省青年医学人才项目(QNRC2016224);苏州市姑苏卫生人才计划项目(2020075);苏州市民生科技项目关键技术应用研究(SS202092);苏州市卫生科教临床重点病种诊疗技术专项(LCZX202026);苏州市企业工程技术研究中心专项(SZS2019263)。

摘　　要：目的探讨多穿支超长股前外侧皮瓣在足踝部环形创面中的临床应用效果。方法回顾性分析2011年10月至2018年6月,苏州大学附属瑞华医院足踝外科修复的13例足踝部环形创面病例资料。术前彩超定位穿支,根据创面大小切取股前外侧皮瓣,保护好进入皮瓣的每一条穿支血管以及进入皮瓣的股外侧皮神经。皮瓣内各皮穿支同源共干时,保留2条及以上皮穿支,皮瓣切取后直接修复创面;皮瓣内皮穿支来源不同不共干时,游离后将不同源的皮穿支通过内增压处理,保证有2条及以上皮穿支营养皮瓣,再修复创面。供区均直接缝合。随访采用英国医学研究会(BMRC)感觉功能评定标准评定皮瓣感觉功能,采用美国足踝外科协会(AOFAS)踝与后足功能评分系统进行功能评定。结果本研究共纳入13例患者,均伴骨肌腱外露,男8例,女5例;年龄21~65岁,平均39岁,创面面积21.0 cm×6.0 cm~35.0 cm×18.0 cm。12例采用多穿支股前外侧皮瓣修复,1例创面巨大,采用双侧多穿支超长股前外侧皮瓣串联并内增压处理后修复,皮瓣面积21.0 cm×7.0 cm~35.0 cm×10.0 cm。术中顺利切取14块皮瓣,9块为2条皮穿支供血,4块为3条皮穿支供血,1块为4条皮穿支供血,每块皮瓣平均2.4条穿支供血。14块皮瓣中皮瓣内穿支同源5块,非同源9块,非同源穿支的皮瓣切取后通过内增压处理再移至受区。14块股前外侧皮瓣全部存活,1块皮瓣于术后24 h发生静脉危象,清除血栓后重新吻合血管,皮瓣顺利存活。均于2~3周伤口愈合后拆线。供区伤口均一期愈合。9块皮瓣因外形臃肿于皮瓣修复术后6~10个月行内固定取出并皮瓣修薄整形。术后随访6~18个月,皮瓣色泽、质地接近受区,BMRC感觉功能评定为S1~S3级。AOFAS踝与后足评分系统评分为72~98分,平均92分。供区均遗留线性瘢痕。结论多穿支超长股前外侧皮瓣血供丰富、抗感染能力强,供区损伤小,是修复足踝Objective To investigate the clinical effect of multiple-perforator extra-large anterolateral thigh flap(ALT)for repairing the circular wound of foot and ankle.Methods Data of 13 cases with the circular wound of foot and ankle repaired by foot and ankle surgery in Ruihua Affiliated Hospital of Soochow University from October 2011 to June 2018 were retrospectively analyzed.The perforator was located by color Doppler ultrasound before the operation,and the flap was designed according to the size of the wound.Both the perforator vessel and lateral femoral cutaneous nerve entering the flap should be carefully protected.When all perforating branches in the flap come from the same vascular trunk,two or more perforating branches are carried to cover the wound directly;when the branches come from the different trunks,the turbocharging technique was used to ensure that there are two or more perforators to nourish the flap.All the donor areas were closed primarily.The sensory of flaps were elevated by the British Medical Research Council(BMRC)sensory function assessment standard,and the motor function was elevated by the American Orthopedic Foot and Ankle Society(AOFAS)ankle and hindfoot function scoring system.Results A total of 13 patients were enrolled in this study,including 8 males and 5 females.The age ranged from 21 to 65 years,with an average of 39 years.The wound area was 21.0 cm×6.0 cm to 35.0 cm×18.0 cm with exposure of bone and tendon.12 cases were repaired with multiple-perforator extra-large anterolateral thigh flap(ALT)harvested from one thigh,and 1 case was repaired with the combined bilateral ALT flap due to the huge wound.The size of flap was 21.0 cm×7.0 cm to 35.0 cm×10.0 cm.During the procedure,14 flaps were successfully harvested,9 flaps were supplied by two perforators,4 by three perforators,and 1 by four skin perforators.Each flap had an average of 2.4 perforators.Among them,there were 5 flaps with the common source perforators while the other 9 flaps whose perforators came from different sources

关 键 词：穿支皮瓣 足损伤 踝损伤 显微外科手术 环形创面 

分 类 号：R658.3[医药卫生—外科学]