游离股前外侧穿支皮瓣修复全段胫骨前贴骨瘢痕伴骨外露创面疗效观察  

Clinical outcomes of free anterolateral thigh perforator flap grafting in repairing adherent scars with bone exposed wounds in full-segment anterior tibial

作　　者：尹凯 张琮[1] 杜伟力[1] 胡骁骅[1] 沈余明[1] 陈欣[1] 陈辉[1] YIN Kai;ZHANG Cong;DU Weili;HU Xiaohua;SHEN Yuming;CHEN Xin;CHEN Hui(Department of Burns and Plastic Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院烧伤整形科,北京100035

出　　处：《解放军医学院学报》2022年第7期724-728,共5页Academic Journal of Chinese PLA Medical School

基　　金：首都卫生发展科研专项项目(首发2020-2-1123);北京市医管局临床技术创新项目(XMLX201838);北京市自然科学基金(7192082);北京积水潭医院科研基金项目(QN-202108)。

摘　　要：背景全段胫骨前贴骨瘢痕伴骨外露创面,小腿整体软组织条件差,临床修复困难。游离股前外侧穿支皮瓣修复全段胫骨前贴骨瘢痕伴骨外露创面的治疗作用需临床观察。目的分析我院创新性应用游离股前外侧穿支皮瓣修复全段胫骨前贴骨瘢痕伴骨外露创面的临床效果。方法回顾性分析2017年9月-2021年9月我院收治的18例全段胫骨前贴骨瘢痕伴骨外露患者的临床资料,分析应用游离股前外侧穿支皮瓣修复全段胫骨前贴骨瘢痕伴骨外露创面的临床效果。结果18例患者中男性8例、女性10例;年龄17~49岁,中位年龄32岁。创面面积22 cm×8 cm~28 cm×15 cm。切取股前外侧穿支皮瓣范围24 cm×10 cm~30 cm×17 cm。18例术后皮瓣均顺利成活,创面Ⅰ期愈合。供区一期直接拉拢缝合或一期缩小创面后二期游离植皮修复,供瓣区切口均Ⅰ期愈合、植皮均顺利成活。术后随访6~12个月,平均9.2个月,患者全段胫骨前贴骨瘢痕伴骨外露创面均得到修复,其中2例皮瓣发生破损,经换药后愈合。结论游离股前外侧穿支皮瓣可修复全段胫骨前贴骨瘢痕伴骨外露创面设计切取灵活,修复全段胫骨前贴骨瘢痕伴骨外露创面效果满意。Background It is challenging to treat adherent scar with bone exposed wounds in the full-segment anterior tibial due to the poor soft tissue condition of the calf in clinical practice.Therefore,free anterolateral thigh perforator flap grafting,a commonly used therapy to address the above challenge,warrants scholarly attention.Objective To observe the effect of free anterolateral thigh perforator flap grafting in treating adherent scar with bone exposed wounds in the full-segment anterior tibial.Methods Clinical data about 18 patients with adherent scars with bone exposed wounds in full-segment anterior tibial who were treated with free anterolateral thigh perforator flaps in our hospital from September 2017 to September 2021 were retrospectively analyzed.Results There were 8 males and 10 females,aged from 17 to 49 years,with median age of 32 years.The wound area ranged from 22 cm×8 cm to 28 cm×15 cm,and the anterolateral thigh perforator flap was 24 cm×10 cm to 30 cm×17 cm in size.The flaps all survived in 18 cases,and all wounds healed by first intention.The donor site was directly closed and sutured in the first intention or was reduced in the first intention and then repaired with free skin grafts in the second intention.The patients were followed up for 6 to 12 months after the operation,with an average of 9.2 months.All patients with adherent scars with bone exposed wounds in full-segment anterior tibial were healed.Among them,2 cases of skin flaps were ruptured and recovered after dressing changes.Conclusion The free anterolateral thigh perforator flap grafting is a flexible option,which can treat adherent scars with bone exposed wounds in the full-segment anterior tibial satisfactorily.

关 键 词：游离股前外侧穿支皮瓣 皮瓣移植 贴骨瘢痕 骨外露 创面修复 

分 类 号：R622[医药卫生—整形外科]