游离植皮包裹血管桥的股前外侧桥式皮瓣在复杂小腿软组织缺损中的应用  

Application of anterolateral thigh bridge flap with free skin graft wrapping vascular bridge in complex calf soft tissue defects

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

机构地区：[1]安徽医科大学第一附属医院显微手足修复重建骨科,合肥230022

出　　处：《中国修复重建外科杂志》2022年第5期619-624,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(81871785)。

摘　　要：目的探讨游离植皮包裹血管桥的股前外侧桥式皮瓣移植修复复杂小腿软组织缺损的临床疗效。方法2018年4月—2021年10月收治11例复杂小腿软组织缺损患者,男9例,女2例;年龄11~60岁,中位年龄39岁。病因:交通事故伤致小腿软组织缺损8例,慢性骨髓炎致小腿皮肤大面积感染3例。彻底清创后皮肤软组织缺损范围10 cm×8 cm~35 cm×10 cm;均伴骨、肌腱外露。9例小腿仅存1条主干血管,2例受区无法找到可与皮瓣血管吻合的血管。切取股前外侧皮瓣(皮瓣范围12 cm×10 cm~37 cm×12 cm)修复软组织缺损。皮瓣供区予以直接缝合(8例)或部分缝合后植皮(3例)处理,血管桥采用中厚皮片缝合包裹。结果术后患者皮瓣均完全成活,无皮瓣坏死、感染及动静脉危象发生。患者血管桥血供通畅,搏动良好,表面回植的中厚皮片色泽红润。11例患者均获随访,随访时间2~40个月,平均19.4个月。皮瓣与周围组织愈合良好,无明显渗出,色差小;皮瓣色泽及温度正常、血运良好、质地柔软,皮瓣外形及小腿轮廓均满意,且患肢功能恢复良好。大腿皮瓣供区创面Ⅰ期愈合,无明显瘢痕形成;皮片供区愈合良好,可见纵向长方形瘢痕,外观满意。结论游离植皮包裹血管桥的股前外侧桥式皮瓣移植是一种治疗复杂小腿软组织缺损的有效方法。Objective To explore the effectiveness of anterolateral thigh bridge flap with free skin graft wrapping vascular bridge in repairing complex calf soft tissue defects.Methods The clinical data of 11 patients with complex calf soft tissue defects between April 2018 and October 2021 were retrospectively analyzed,including 9 males and 2 females,aged 11-60 years,with a median age of 39 years.There were 8 cases of calf soft tissue defect caused by traffic accident,and3 cases of calf skin infection caused by chronic osteomyelitis.The skin and soft tissue defects ranged from 10 cm×8 cm to35 cm×10 cm after thorough debridement and accompanied with bone and tendon exposure.There was only one main vessel in calf of 9 cases and no blood vessel that could be anastomosed with the flap vessel could be found in the recipient site of 2 cases.The anterolateral thigh skin flap(the flap size ranged from 12 cm×10 cm to 37 cm×12 cm)was taken to repair the soft tissue defect.The donor site of the flap was treated with direct suture(8 cases)or partial suture followed by skin grafting(3 cases),and the vascular bridge was wrapped with medium-thickness skin graft.Results The flaps of 11patients survived completely without necrosis,infection,and vascular crisis.The blood supply of the vascular bridge was unobstructed and the pulse was good.The color of the medium-thickness skin graft were ruddy.All 11 patients were followed up 2-40 months,with an average of 19.4 months.The flaps healed well with the surrounding tissues without obvious exudation and color difference.The flaps had normal color and temperature,good blood supply,and soft texture.The shape of the flap and calf contour were satisfactory and the function of the limb recovered well.The donor area of thigh flap healed by first intention without obvious scar formation.The donor area of skin healed well with a longitudinal oblong scar only and the appearance was satisfactory.Conclusion The anterolateral thigh bridge flap transplantation with free skin wrapping vascular bridge is a

关 键 词：股前外侧皮瓣 小腿 软组织缺损 桥式皮瓣 血管桥 

分 类 号：R658.3[医药卫生—外科学]