超薄股前外侧皮瓣修复手足创伤性软组织缺损的临床研究  

Clinical study of ultra-thin anterolateral thigh perforator flap for repair of traumatic soft tissue defects of hand and foot

作　　者：颜海彬 方崇斌 张炳云 郭新辉 Yan Haibin;Fang Chongbin;Zhang Bingyun;Guo Xinhui(Department of Hand Surgery,the First People's Hospital of Wenling of Zhejiang Province,Werding 317500,China)

机构地区：[1]浙江省温岭市第一人民医院手外科,温岭317500

出　　处：《中华手外科杂志》2022年第1期35-38,共4页Chinese Journal of Hand Surgery

基　　金：温岭市科技计划社会项目(2017C31BA0178)。

摘　　要：目的分析超薄股前外侧皮瓣修复手足创伤性软组织缺损的临床效果。方法自2017年12月至2019年12月,我们采用超薄游离股前外侧皮瓣治疗手足创伤性软组织缺损患者15例,软组织缺损部位:手4例,足11例。记录每例的手术时间及发生血管危象的病例数,根据术后存活情况分为两类:完全存活皮瓣,部分坏死皮瓣。在术后3.6及12个月进行随访,记录床次随访的临床数据:供区的切口愈合评分、术后手功能评价采用中华医学会手外科学会上肢部分功能评定试用标准,足功能评价采用Maryland足功能评分。结果本组15例超薄股游离前外侧皮瓣全部存活,平均手术时间为(5.1±0.6)h,皮瓣的平均厚度为(6.2±1.1)mm,皮瓣面积大小为8 cm×5 cm~22 cm×10 cm。1例术后第3天发生静脉危象,经创口拆线清除压迫皮瓣蒂部的血肿后存活。本组无一例发生感染,1例皮瓣供区伤口延迟愈合,经换药2周后闭合。12例供区一期闭合,愈合评分(HWES评分)为1.1±0.6;3例植皮修复供区愈合评分(VSS评分)为4.1±0.7。11例足部患者按Maryland足功能评分为86.16±3.59,优6例、良3例、可1例、差1例;4例手部患者按中华医学会手外科学会上肢功能评定标准评定:优1例,良3例。结论与传统股前外侧皮瓣相比,超薄股前外侧皮瓣具有厚度更薄、与手足供区皮肤匹配程度更高、无需二次整形手术等优点,患肢术后功能恢复满意,是一种较理想的修复手足创伤性软组织缺损的方法。Objective To analyze the clinical efficacy of ultra-thin anterolateral thigh perforator flap for repair of traumatic soft tissue defects of hand and foot.Methods From December 2017 to December 2019,15 patients with traumatic soft tissue defects of hand and foot were treated by ultra-thin anterolateral thigh perforator flap.The location of soft tissue defects was hand in 4 cases and foot in 11 cases.The operation time and the number of cases with vascular crisis were recorded.According to the postoperative survival,they were divided into two categories,completely viable flap and partially necrotic flap.The patients were followed up at 3,6 and 12 months after operation,and the clinical data of the last follow-up were recorded including the incision healing score.The postoperative hand function was evaluated by the trial standard of upper limb function evaluation issued by the Hand Surgery Society of Chinese Medical Association,and the foot function was evaluated by Maryland foot function score.Results All the 15 cases of ultra-thin anterolateral thigh perforator flap survived with the average operation time being(5.1±0.6)hours.The average thickness of the flap was(6.2±1.1)mm,and the area of the flap was 8 cm × 5 cm to 22 cm × 10 cm.The venous crisis occurred in one case the third day after operation and it survived after removing the hematoma compressing the pedicle of the flap.No infection occurred in the 15 cases.One case of flap donor site wound delayed healing and closed after dressing change for 2 weeks.12 donor sites achieved primary healing,and the healing score(HWES score)was 1.1±0.6.The skin graft donor site healing score(VSS score)of 3 cases was 4.1±0.7.According to Maryland's foot function score,the results of 11 patients with foot soft tissue defects were 86.16±3.59,which rated as excellent in 6 cases,good in 3 cases,fair in 1 case and poor in 1 case.According to the trial standard of upper limb function evaluation issued by the Hand Surgery Society of Chinese Medical Association,the results of 4

关 键 词：外科皮瓣 治疗结果 超薄股前外侧皮瓣 软组织缺损 

分 类 号：R658[医药卫生—外科学]