游离股前外侧皮瓣移植修复足踝部深度软组织缺损  

Free anterolateral thigh flap transplantation for repairing deep soft tissue defects of the foot and ankle

作　　者：徐应龙[1] 戴海[1] 熊杰 吴永祥[1] 黄彩丽 黄宗贵[1] XU Ying-long;DAI Hai;XIONG Jie;WU Yong-xiang;HUANG Cai-li;HUANG Zong-gui(Dept of Traumatic Orthopaedics,the First People′s Hospital of Nanning,Nanning,Guangxi 530022,China)

机构地区：[1]南宁市第一人民医院创伤骨科,广西南宁530022

出　　处：《临床骨科杂志》2022年第5期669-673,共5页Journal of Clinical Orthopaedics

摘　　要：目的 探讨游离股前外侧皮瓣移植修复足踝部深度软组织缺损的临床疗效。方法 采用游离股前外侧皮瓣移植修复29例足踝部深度软组织缺损患者。皮肤软组织缺损面积为8 cm×5 cm~24 cm×16 cm,皮瓣设计面积11 cm×6 cm~26 cm×18 cm。结果 26例供区创面闭合为线性伤口,3例供区切取下腹部全厚皮片移植修复。1例术后出现动脉危象,1例术后出现静脉危象;其他皮瓣均一期顺利成活。3例皮瓣伤口延期愈合,其余供、受区创面均一期愈合。患者均获得随访,时间8~11个月。末次随访时,受区皮瓣色泽、质地良好,感觉恢复至S2~S4级,皮瓣有不同程度臃肿,有2例明显影响外观,行二期皮瓣修薄术;供区愈合良好,无瘢痕或明显巨大增生瘢痕,下肢无感觉或运动功能障碍。末次随访时,20例踝部缺损修复采用AOFAS踝-后足评分评价疗效:优10例,良8例,可1例,差1例,优良率18/20;排除1例因动脉危象后未能恢复改交腿皮瓣修复者,其余8例足部缺损修复采用JOA评分评价疗效:优5例,良2例,可1例,优良率7/8。结论 游离股前外侧皮瓣移植修复足踝部深度软组织缺损可获得满意的临床疗效。Objective To investigate the clinical effect of free anterolateral thigh flap transplantation for repairing deep soft tissue defect of foot and ankle.Methods The 29 cases of deep soft tissue defects of foot and ankle were repaired with free anterolateral thigh flap. The defect area of skin and soft tissue was 8 cm × 5 cm ~ 24 cm × 16 cm,and the design area of skin flap ranged from 11 cm × 6 cm to 26 cm × 18 cm.Results In 26 cases,the donor site was closed as linear wounds;and in 3 cases,full-thickness abdominal skin was removed to repair the donor site. After operation,there were 1 case of arterial crisis and 1 case of venous crisis, and the other flaps survived smoothly. The wound healing was delayed in 3 cases,and wound healing in other donor and recipient areas were primary. All patients were followed up for 8 ~ 11 months. At the last follow-up,the color and texture of the skin flap in the affected area were good,and the sensation was restored to S2 ~ S4 levels. The skin flap was swollen to varying degrees,and 2 cases had obvious influence on appearance,so the second stage flap thinning was performed. The donor site healed well,without keloid or obvious hyperplastic scar,and there were no sensory or motor dysfunction of lower limbs. At the last follow-up,the efficacy evaluation results of 20 cases with ankle defects assessed with AOFAS ankle-hindfoot score:excellent in 10 cases,good 8 cases,fair 1 case,and poor 1 case,with an excellent-good rate of 18/20;except for 1 patient who failed to recover due to arterial crisis,the cross-leg flap repair was performed;the effect evaluation results of8 cases with feet defects assessed with JOA score:excellent in 5 cases,good in 2 cases,fair in 1 case,with an excellent-good rate of 7/8.Conclusions Free anterolateral thigh flaps transplantation can get satisfactory effect in repairing deep soft tissue defects of foot and ankle.

关 键 词：股前外侧皮瓣 足踝损伤 软组织缺损 

分 类 号：R622.1[医药卫生—整形外科] R658.3[医药卫生—外科学]