ALTF联合MPF修复足部脱套伤  

Repair of foot degloving injury by ALTF combined with MPF

作　　者：李贤海[1] 周建东 陈政 许亚军 LI Xianhai;ZHOU Jiandong;CHEN Zheng;XU Yajun(Department of Orthopeadics,Zhoushan Hospital,Zhoushan,Zhejiang Province 316021,China;Department of Podiatric Surgery,Wuxi No.9 People's Hospital,Wuxi,Jiangsu Province 214062,China)

机构地区：[1]浙江省舟山医院骨科,浙江舟山316021 [2]无锡市第九人民医院足踝外科,江苏无锡214062

出　　处：《中华显微外科杂志》2021年第6期637-641,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨应用游离股前外侧皮瓣(ALTF)联合健侧足底内侧皮瓣(MPF)移植修复前中足脱套伤的临床疗效。方法2016年5月至2019年11月,采用游离ALTF联合健侧MPF修复前中足脱套伤共6例,男4例,女2例;年龄35~55岁,平均43岁。创面大小15 cm×12 cm~19 cm×14 cm,MPF切取面积8 cm×5 cm~10 cm×6 cm,ALTF切取面积16 cm×7 cm~20 cm×8 cm。采用ALTF覆盖足背及足侧方创面,皮瓣动脉与足背动脉吻合,采用MPF修复足底负重区,皮瓣动脉与患侧足底内侧动脉吻合。所有患者均获得门诊或微信随访,并记录皮瓣外观及肢体恢复情况。结果6例MPF及ALTF均顺利成活,供、受区创面均一期愈合。术后随访9~18个月,平均14个月。末次随访时,皮瓣外形良好,质地柔软,并恢复部分保护性感觉,足部外形及功能恢复满意。足功能Maryland评分优秀(90~100分)4例,良(75~89分)2例,平均91.2分。根据英国医学研究会(BMRC)感觉评定标准对足底皮瓣感觉功能进行评定,1例S1,3例S2,2例S3。结论应用ALTF联合MPF移植修复前中足脱套伤效果良好,功能满意。Objective To investigate the clinical effect of free anterolateral thigh flap(ALTF)combined with medial plantar flap(MPF)transfer in repairing forefoot and mid-foot degloving injury.Methods From May,2016 to November,2019,6 patients with forefoot and mid-foot degloving injuries underwent reconstructions using free ALTF combined with MPF.The study included 4 males and 2 females patients with an average of 43(range,35-55)years.The size of soft tissue defects was 15 cm×12 cm-19 cm×14 cm.The dimension of the MPF was 8 cm×5 cm-10 cm×6 cm,and that of ALTF was 16 cm×7 cm-20 cm×8 cm.The ALTF was used to cover the dorsal and lateral foot,the flap artery was anastomosed to the dorsalis pedis artery.The MPF was used to repair the weight-bearing area of the forefoot,the flap artery was anastomosed to the medial plantar artery in recipient site.All patients entered follow-up by outpatient clinic or Wechat for 9-18(mean,14)months,and the appearance of flap and limb function were recorded.Results The MPF and ALTF survived uneventfully in all 6 patients,and the wound in donor and recipient areas healed in one stage.At the last follow-up,the flaps had satisfactory contour,the texture of the flaps was soft,the protective sensation was recovered,and the appearance and function of the foot recovered satisfactorily.The Maryland score of reconstructed foot function was considered excellent(90-100)in 4 cases and good(75-89)in 2 cases.The average Maryland score was 91.2.Conclusion ALTF combined with MPF generated good effect and satisfactory function in repairing forefoot and mid-foot degloving injury.

关 键 词：股前外侧皮瓣 足底内侧皮瓣 移植 足部脱套伤 显微外科技术 

分 类 号：R658.3[医药卫生—外科学]