Flow-through股前外侧穿支皮瓣或腓肠内侧动脉穿支皮瓣修复足部Gustilo Ⅲ C型损伤创面  

Flow-through anterolateral thigh perforator flap or medial sural artery perforator flap in repair of GustiloⅢC wound of foot

作　　者：沈学强[1] 戴锋[1] 林顺 周建东 SHEN Xueqiang;DAI Feng;LIN Shun;ZHOU Jiandong(Department of Orthopaedics and Traumatology,Suzhou Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine,Suzhou,Jiangsu Province 215009,China;Department of Foot and Ankle Surgery,Wuxi No.9 People's Hospital,Wuxi,Jiangsu Province 214062,China)

机构地区：[1]南京中医药大学附属苏州市中医医院骨伤科,江苏苏州215009 [2]无锡市第九人民医院足踝外科,江苏无锡214062

出　　处：《中华显微外科杂志》2022年第4期377-382,共6页Chinese Journal of Microsurgery

基　　金：无锡市卫生健康委员会科研项目(M202156)。

摘　　要：目的探讨应用Flow-through股前外侧穿支皮瓣(ALTPF)或腓肠内侧动脉穿支皮瓣(MSAPF)一期修复足部Gustilo Ⅲ C型损伤创面的临床疗效。方法 2015年7月至2021年6月, 在无锡市第九人民医院足踝外科治疗的足部Gustilo Ⅲ C型损伤患者共8例, 其中男7例, 女1例;年龄25~62(45.88±12.96)岁。根据创面大小、血管缺损长度及口径选择Flow-through ALTPF或Flow-through MSAPF修复足部创面, 其中6例行游离Flow-through ALTPF修复,2例行游离Flow-through MSAPF修复, 皮瓣切取面积9 cm×5 cm~22 cm×8 cm[(115.00±46.16) cm^(2)], 血管桥接长度6~12(8.75±2.50) cm。所有患者均获得门诊随访, 记录皮瓣外观、患肢血运、骨折脱位愈合及肢体功能恢复情况, 应用Maryland评分评价功能恢复情况。结果所有8例患者皮瓣均成活, 受区一期愈合。术后随访6~22(12.25±5.39)个月。末次随访时皮瓣外形良好, 质地柔软, 患肢血运良好, 桥接血管通畅, 骨折和脱位均愈合, 足部外形及功能恢复较满意。足部Maryland功能评分:优3例, 良4例, 可1例。结论临床可以根据创面大小、血管缺损长度及口径选择运用Flow-through ALTPF或Flow-through MSAPF急诊一期修复足部Gustilo Ⅲ C型损伤创面, 后期患肢功能恢复满意, 具有较好的临床疗效。Objective To investigate the therapeutic effect of Flow-through anterolateral thigh perforator flap(ALTPF)or medial sural artery perforator flap(MSAPF)in repair of Gustilo III C wound of foot.Methods From July 2015 to June 2021,8 patients with Gustilo III C wound of foot were treated in the Department of Foot and Ankle Surgery of Wuxi No.9 People’s Hospital.The patients were 7 males and 1 female,aged 25-62 years old,and(45.88±12.96)years old in average.Flow-through ALTPF or Flow-through MSAPF were used to repair the defect according to the size of the wound and the length and diameter of the defect vascular.Among the patients,6 were repaired with free Flow-through ALTPF,and 2 with free Flow-through MSAPF.The size of flap was 9 cm×5 cm-22 cm×8 cm with(115.00±46.16)cm2 in average,and the vascular bridging was 6-12 cm in length,with(8.75±2.50)cm in average.All patients received outpatient follow-up.The appearance of the flap,blood supply of affected limb,healing of fracture and dislocation and the recovery of limb function were recorded.Maryland score was used to evaluate functional recovery.Results The flaps survived uneventfully in all 8 patients,and the wounds in donor site healed primarily.All patients were followed-up for 6-22 months with(12.25±5.39)months in average.At the last follow-up,all the flaps had satisfactory contour in soft texture and blood supply without occlusion in the bridging vessels.The fractures and dislocation were healed,and the appearance and function of the foot recovered satisfactorily.The Maryland score showed excellent in 3 patients,good in 4 patients and fair in 1 patient.Conclusion Flow-through ALTPF or MSAPF can selectively used to reconstruct the Gustilo III C wound of foot in one stage.The functional recovery of the affected limb was satisfactory and the clinical effect was good.

关 键 词：足部开放伤 血流接桥皮瓣 股前外侧穿支皮瓣 腓肠内侧动脉穿支皮瓣 移植 

分 类 号：R658.3[医药卫生—外科学]