薄型游离旋股外侧动脉穿支皮瓣修复手足部瘢痕挛缩畸形  

Application of thin free lateral femoral circumflex artery perforator flap in repair of scar contracture deformity in hand and foot

作　　者：肖顺娥 张天华 吴必华 李海 魏在荣 王达利 邓呈亮 XIAO Shun’e;ZHANG Tianhua;WU Bihua;LI Hai;WEI Zairong;WANG Dali;DENG Chengliang(Department of Burn and Plastic Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou,563000,P.R.China)

机构地区：[1]遵义医科大学附属医院烧伤整形外科,贵州遵义563000

出　　处：《中国修复重建外科杂志》2022年第2期220-223,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：贵州省科技计划项目(黔科合基础[2020]1Y331);贵州省卫生健康委科学技术基金项目(gzwjkj 2019-1-152);遵义市优秀青年科技创新人才培养项目(遵市科合HZ字2019-51号)。

摘　　要：目的探讨薄型游离旋股外侧动脉穿支皮瓣修复手、足部瘢痕挛缩畸形的疗效。方法 2017年1月—2020年10月,收治15例手、足部瘢痕挛缩畸形患者。男9例,女6例;年龄6~42岁,中位年龄23岁。瘢痕挛缩时间1~21年,中位时间13年。瘢痕挛缩畸形位于手部11例、足部4例;导致不同程度手、足部关节功能障碍。术中瘢痕挛缩松解后遗留创面范围为6 cm×4 cm~9 cm×8 cm;合并血管、神经或者肌腱外露12例,肌腱缺损4例。经浅筋膜浅层切取薄型游离旋股外侧动脉穿支皮瓣修复,皮瓣切取范围为6.0 cm×5.0 cm~10.0 cm×8.5 cm;取阔筋膜条重建肌腱。皮瓣供区减张缝合。结果术后1例皮瓣出现静脉血管危象,经对症处理后皮瓣成活;其余皮瓣均顺利成活,创面Ⅰ期愈合。皮瓣供区切口均Ⅰ期愈合。患者均获随访,随访时间6~12个月,平均9个月。皮瓣外形、质地良好。患手功能明显改善,末次随访时按照中华医学会手外科学会上肢部分功能评定试用标准,获优7例、良4例。患足足趾关节畸形及功能均明显改善。供区无肌疝、感觉麻木等并发症发生。结论经浅筋膜浅层切取的薄型游离旋股外侧动脉穿支皮瓣修复手、足部瘢痕挛缩畸形松解后创面,可获得良好外观及功能,而且供区并发症少。Objective To explore the effectiveness of thin free lateral femoral circumflex artery perforator flaps that dissected under the superficial fascia in repair of scar contracture deformity in hand and foot. Methods Between January 2017 and October 2020, 15 patients with scar contracture deformity in hand or foot were admitted. There were9 males and 6 females;aged 6-42 years, with a median age of 23 years. Scar contracture lasted from 1 to 21 years, with a median of 13 years. There were 11 cases of scar contracture deformities in the hands and 4 cases in the feet, all of which showed different degrees of hand and foot joint dysfunction. After the scar contracture was released, the size of wounds ranged from 6 cm×4 cm to 9 cm×8 cm, including 12 cases with exposure of blood vessels, nerves, or tendons, and 4 cases with tendon defects. A thin free lateral circumflex femoral artery perforator flap that dissected under the superficial fascia was used to repair the wound. The size of flap ranged from 6.0 cm×5.0 cm to 10.0 cm×8.5 cm. Fascia strips were used to reconstruct tendons and the donor sites were sutured directly. Results The venous vascular crisis occurred in 1 flap, and the flap survived successfully after treatment. The rest flaps survived well, and the wounds healed by first intention. All incisions at donor sites healed by first intention. All patients were followed up 6-12 months after operation, with an average of 9 months. The flaps were in good shape and texture. The functions of the affected hand had been restored to a large extent. According to the upper limb function evaluation standard of the Society of Hand Surgery of the Chinese Medical Association, 7 cases were excellent and 4 cases were good. The deformity of the toe joint of the affected foot significantly improved. No muscular hernia, sensory numbness, or other complications occurred at the donor sites.Conclusion The thin free lateral femoral circumflex artery perforator flap that dissected under the superficial fascia is an effective method

关 键 词：旋股外侧动脉穿支皮瓣 薄型皮瓣 瘢痕挛缩 创面修复 

分 类 号：R658[医药卫生—外科学]