显微削薄-嵌合旋股外侧动脉降支穿支皮瓣修复四肢复杂软组织缺损  

Repairing of composite soft tissue defects in limbs with micro-dissected chimeric perforator flap pedicled with the descending branch of lateral circumflex femoral artery

作　　者：唐举玉[1] 王玉玲 吴攀峰[1] 俞芳[1] 卿黎明[1] 潘丁[1] 庞晓阳[1] 曾磊[1] 肖勇兵[1] 刘睿[1] TANG Juyu;WANG Yuling;WU Panfeng;YU Fang;QING Liming;PAN Ding;PANG Xiaoyang;ZENG Lei;XIAO Yongbing;LIU Rui(Department of Orthopaedics,Micro&Hand Surgery,Xiangya Hospital of Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院骨科-手显微外科,长沙410008

出　　处：《中华显微外科杂志》2021年第6期621-624,共4页Chinese Journal of Microsurgery

基　　金：国家自然科学基金(81871577)。

摘　　要：目的探讨以旋股外侧动脉降支(d-LCFA)为蒂的显微削薄-嵌合(II-MCh)穿支皮瓣移植修复合并深部死腔的四肢复杂软组织缺损的可行性及临床疗效。方法自2011年4月至2019年12月,收治四肢合并深部无效腔的复杂软组织缺损患者19例,均采用以d-LCFA为蒂的II-MCh穿支皮瓣或显微削薄-分叶-嵌合(III-MPCh)穿支皮瓣移植修复,其中显微削薄的穿支皮瓣覆盖浅表创面,肌瓣填塞深部死腔。皮瓣切取面积6.0 cm×3.0 cm~33.0 cm×8.0 cm,肌瓣切取体积5.0 cm×3.0 cm×1.0 cm~13.0 cm×10.0 cm×1.5 cm,皮瓣供区直接闭合。术后1、3、6、9、12个月随访,记录皮瓣的外形、颜色、质地及感染复发情况。结果术后16例皮瓣一期顺利成活。2例出现静脉危象,1例出现动脉危象,予以探查重新吻合受区血管后皮瓣成活。随访8~36个月,平均16个月,受区皮瓣皮肤质地柔软,外形不臃肿,皮瓣供区均一期愈合,供区仅遗留线形瘢痕。结论以d-LCFA为蒂的II-MCh穿支皮瓣既可一次性均匀削薄,使皮瓣受区获得满意外观,同时又可有效填塞深部死腔,实现了创面的立体修复,体现了"微创、美学"的修复理念,是修复四肢合并深部死腔的软组织缺损的有效方法。Objective To evaluate the feasibility and clinical results of micro-dissected chimeric(II-MCh)perforator flap based on the descending branch of lateral circumflex femoral artery(d-LCFA)for repairing composite soft tissue defects of limbs.Methods From April,2011 to December,2019,a total of 19 cases of composite soft tissue defects of limbs combined with deep cavity were repaired with II-MCh perforator flap or micro-dissected thin lobulated(III-MPCh)perforator flap based on d-LCFA.The flap was micro-dissected before cut off the perforator.The deep dead cavity was filled with muscle flap,and the superficial wound was repaired with micro-dissected thin perforator flap.The sizes of flaps were 6.0 cm×3.0 cm-33.0 cm×8.0 cm.The muscle flaps were cut with volumes of 5.0 cm×3.0 cm×1.0 cm-13.0 cm×10.0 cm×1.5 cm.Donor sites of the flap were closed directly.Postoperative reviews were assigned at 1,3,6,9 and 12 months.The appearance,colour,texture and recurrence of infection of the flap were checked and recorded.Results Sixteen flaps survived successfully without necrosis and with primary healing at the donor sites.Two flaps had venous occlusion within 24 hours after surgery and healed after surgical exploration and venous anastomosis.One flap had arterial crisis within 24 hours after surgery and healed after surgical exploration and arterial anastomosis.All patients entered follow-up for 8-36 months with an average of 16 months.All recipient sites achieved satisfactory appearance and function,and only linear scars left at the donor sites.Conclusion The II-MCh perforator flap based on d-LCFA is a special modality of anterolateral thigh perforator flap,which achieves a satisfying appearance at the recipient site by micro-dissecting the flap within one procedure.This emerging technique can effectively fill the dead cavity,and is an effective method to repair complex soft tissue defects of limbs combined with deep cavity.

关 键 词：旋股外侧动脉降支 显微削薄嵌合皮瓣 特殊形式穿支皮瓣 四肢 修复 

分 类 号：R658[医药卫生—外科学]