游离股前外侧皮瓣移植治疗合并近端主干血管损伤的下肢软组织缺损  

Free anterolateral thigh flap transfer to repair soft tissue defect combined with proximal major vascular injury in lower extremity

作　　者：刘重 郭永明 马宁 滕云升 吴珂 LIU Zhong;GUO Yong-ming;MA Ning;TENG Yun-sheng;WU Ke(Department of Traumatic Orthopaedic,Xi’an 521 Hospital,Xi’an,Shaanxi 710065,China)

机构地区：[1]兵器工业五二一医院创伤骨科(陕西手显微外科研究所),陕西西安710065

出　　处：《中国骨与关节损伤杂志》2022年第4期373-377,共5页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨游离股前外侧皮瓣移植治疗合并近端主干血管损伤的下肢软组织缺损的临床应用方法及疗效。方法回顾性分析自2012-06—2019-06采用游离股前外侧皮瓣移植治疗合并近端主干血管损伤的10例下肢软组织缺损,一期手术修复主干血管损伤重建肢体血运,二期手术采用游离股前外侧皮瓣修复软组织缺损。结果10例术后均获得随访,随访时间平均20个月。近端主干血管修复后肢体血运良好,缺血症状均获得明显改善。移植的股前外侧皮瓣全部成活,8例创面一期愈合,2例创面二期愈合,愈合时间14~24 d。3例行胫后肌腱转位术,术后踝关节主动背伸至10°。股前外侧皮瓣供区直接缝合2例,创面缩小后植皮8例,均无功能障碍。4例健侧胫后动脉交腿桥式供血患者术后健侧无功能障碍。结论合并近端主干血管损伤的下肢软组织缺损患者临床少见,容易漏诊且治疗较为棘手,一期手术修复近端主干血管重建肢体血运、二期手术采用游离股前外侧皮瓣修复软组织缺损是理想的治疗方法。Objective To explore the clinical application and effect of free anterolateral thigh flap transfer to repair soft tissue defect combined with proximal main vascular injury in lower extremity.Methods Ten cases of lower extremity soft tissue defects with proximal main vascular injury were treated with free anterolateral thigh skin flap transplantation from June 2012 to June 2019.The first-stage operation repaired the main vascular injury and reconstructed the blood supply of the limb,and the second-stage operation used free anterolateral thigh flap to repair soft tissue defect.Results All cases were followed up,and the average follow-up time was 20 months.After the repair of the proximal main vessels,the blood supply of the limbs was good,and the ischemic symptoms were significantly improved.All the transplanted anterolateral thigh flaps survived.The wounds of 8cases healed in the first stage,and the wounds of 2 cases healed in the second stage,and the healing time was 14-24 d.3 cases underwent transposition of the tibialis posterior tendon,and the ankle joint was actively extended to 10°postoperatively.The donor site of the anterolateral thigh flap was sutured in 2 cases,and skin grafted in 8 cases.The 4 patients with contralateral posterior tibial artery cross-leg bridge blood supply had good postoperative function.Conclusion Patients with lower extremity soft tissue defects combined with proximal main vascular injury are rare in clinic,easy to be missed and difficult to treat.One-stage operation to repair proximal main vessels to reconstruct limb blood supply,and second-stage operation to repair soft tissue defect with free anterolateral thigh flap is an ideal treatment method.

关 键 词：下肢主干血管损伤 下肢软组织缺损 游离股前外侧皮瓣 血运重建 

分 类 号：R628[医药卫生—整形外科]