桥式交叉"Y"形血管吻合ALTF移植修复小腿复杂软组织缺损33例  

Repair of complex soft tissue defect in calf by ALTF with a cross-limb bridged“Y”shape vascular anastomo・sis:a report of 33 cases

作　　者：周洪翔[1] 何亮 尹东 金哲 牛杨 王子富 黄俊[1] 周涛[1] 周定[1] 钟林[1] ZHOU Hongxiang;HE Liang;YIN Dong;JIN Zhe;NIU Yang;WANG Zifu;HUANG Jun;ZHOU Tao;ZHOU Ding;ZHONG Lin(Department of Microsurgical Repair and Reconstruction&Foot and Ankle Surgery,The First Affiliated Hospital of A nhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院显微修复重建及足踝病区,合肥230022

出　　处：《中华显微外科杂志》2022年第1期28-32,共5页Chinese Journal of Microsurgery

基　　金：国家自然科学基金(81871785)。

摘　　要：目的探索桥式交叉"Y"形血管吻合ALTF移植修复复杂性小腿软组织缺损的临床疗效.方法2010年8月-2020年9月,对于严重外伤造成的复杂性小腿软组织缺损33例,术中探查或血管造影见患侧小腿仅存1条主干血管或受区创面无可与皮瓣血管蒂吻合的血管,应用ALTF血管蒂动脉与健侧小腿胫后动脉"Y"形吻合重建移植皮瓣血运的方法,游离移植ALTF修复复杂小腿外伤性软组织缺损.33例皮瓣面积16cm×8 cm~25 cm×18 cm,其中分叶皮瓣2例.将移植皮瓣的血管蒂动脉近端"Y"形血管嵌于健侧切断的踝上胫后动脉两端,皮瓣静脉与胫后动脉伴行静脉或大隐静脉吻合.悬空的血管"桥"表面应用游离皮片包裹,用外固定支架将双下肢伸直位固定.大腿皮瓣供区予以直接缝合或缝合后植皮处理.术后3~6周血管桥断蒂.出院后门诊随访.结果33例患者中皮瓣完全成活31例,坏死1例,皮瓣远端部分坏死1例.随访时间13个月~7年,平均25个月,皮瓣血运良好,质地柔软,外观满意;健肢胫后动脉术后行多普勒或DSA检查,血管搏动及通畅度正常;大腿供区切口及植皮愈合均良好.结论桥式交叉"Y"形血管吻合ALTF移植技术是解决小腿仅存1条主干血管或受区创面无可与皮瓣血管蒂吻合的血管的复杂性小腿软组织缺损行之有效的技术之一.Objective To explore the clinical effect of ALTF transfer with cross-limb bridged"Y"shape vascular anastomosis in repair of complex soft tissue defects in calf.Methods From August 2010 to September 2020,33 patients(23 males and 10 females)with complex traumatic soft tissue defects in calf were treated.Preoperative angiography and intraoperative exploration confirmed that there was only 1 main vessel remained in the affected calf or the wound surface and the vessel could not be anastomosed with the vascular pedicle of the ALTF.The size of flap were 16 cm x 8 cm to 25 cm x 18 cm.Two patients received bilobed ALTFs.A"Y"shape anastomosis between the artery of ALTF vascular pedicle and the posterior tibial artery of the contralateral lower limbs was made in all 33 patients to establish the blood supply to the transferred free ALTF.The"Y"shape cross-limb bridged blood vessels at the proximal end of the vascular pedicle artery of the flap were embedded at both ends of the cut-off superior ankle posterior tibial artery of the contralateral lower limb.The vein of the flap was anastomosed with the saphenous vein that associates with the posterior tibial artery.The surface of the suspended blood vessel"bridge"was wrapped with a free skin craft,and the lower limbs were fixed in a straight and parallel position with an external fixation frame.The perfused area of the flap was directly sutured or covered with a free skin craft.The vascular bridge was kept for 3 to 6 weeks before being separated.Outpatient follow-up after discharge.Results All the patients were entered the post・operative follow-up was 13 months to 7 years,in an average of 25 months.Among the 33 flaps,31 survived completely,except 1 had necrosis and the other 1 had partial necrosis at the distal end of the flap.The flaps received good bl ood supply,hence with soft texture and satisfactory appearance.Doppler or DSA was performed after the surgery on the posterior tibial artery of the healthy limb,and the vascular pulsation and patency were found normal.Donor si

关 键 词：股前外侧皮瓣 桥式皮瓣 小腿 软组织缺损 胫后动脉 

分 类 号：R658.3[医药卫生—外科学]