以旋股外侧动脉降支为蒂的分叶-嵌合穿支皮瓣修复足踝多部位缺损伤六例  

Repair of multiple defects of foot and ankle with lobulated chimeric perforator flap pedicled with descending branch of lateral femoral circumflex artery:Report of 6 cases

作　　者：吴文溢 余少校 周望高 张振伟 WU Wenyi;YU Shaoxiao;ZHOU Wanggao;ZHANG Zhenwei(Department of Hand Surgery,Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine,Shenzhen,Guangdong Province 518104,China)

机构地区：[1]深圳市中西医结合医院手外科,广东深圳518104

出　　处：《中华显微外科杂志》2022年第4期400-405,共6页Chinese Journal of Microsurgery

基　　金：深圳市宝安区科技创新局科研项目(2020JD341)。

摘　　要：目的探讨以旋股外侧动脉降支(d-LCFA)为蒂的分叶-嵌合穿支皮瓣修复足踝多部位的复合组织缺损创面的临床效果。方法自2017年2月至2021年3月, 深圳市中西医结合医院手外科共收治6例足踝多部位缺损伤患者, 软组织缺损面积14.0 cm×9.0 cm~28.0 cm×9.0 cm, 皮瓣切取面积为15.0 cm×10.0 cm~29.0 cm×10.0 cm, 创面均骨外露且合并不同程度感染。一期创面清创后使用VSD持续灌洗引流, 二期行d-LCFA分叶-嵌合穿支皮瓣覆盖缺损创面。术后门诊定期随访患者皮瓣颜色、质地及感觉恢复情况。结果全部皮瓣均顺利成活, 无血管危象, 术后随访10~12个月, 未发现感染病灶复发, 皮瓣无色素沉着, 质地柔软, 外形不臃肿, 耐磨性好, 按照英国医学研究会(BMRC)制定的手感觉功能评定标准, 恢复部分痛觉与触觉(达S1~S2)。结论 d-LCFA分叶-嵌合穿支皮瓣只需吻合1组血管蒂, 既可同时覆盖多部位不同深度的创面, 又能抗感染, 是修复足踝多部位复合组织缺损伤的较理想皮瓣。Objective To investigate the clinical effect of lobulated chimeric perforator flap pedicled with descending branch of lateral circumflex femoral artery(d-LCFA)in repair of multiple composite tissue defects of the foot and ankle.Methods From February 2017 to March 2021,a total of 6 patients with foot and ankle multiple site deficiency injuries were treated in the Department of Hand Surgery,Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine.The area of the soft tissue defect was 14.0 cm×9.0 cm~28.0 cm×9.0 cm.The size of the flap were 15.0 cm×10.0 cm-29.0 cm×10.0 cm.In all the cases,the wounds were complicated with bone defects and different degrees of infection.After primary debridement,VSD was used for continuous lavage and drainage.In the second stage,the defect was repaired with a lobulated chimeric perforator flap of d-LCFA.The colour,texture and sensory recovery of flap were observed in the scheduled postoperative follow-up.Results All flaps survived smoothly without vascular crisis.After 10-12 months of follow-up,no recurrence of infection was found.The flaps had no pigmentation,soft in texture,with non-bloated appearance,good wear resistance,and recovered part of sensation.According to the British Medical Research Council(BMRC)hand sensory function evaluation standard,the sensation recovered to S1-S2.Conclusion The lobulated chimeric perforator flap pedicled with d-LCFA only requires microanastomosis with 1 vascular pedicle.It simultaneously covers wounds in different depths at multiple sites and is also anti-infective.It is an ideal flap for repairing multi-site composite tissue defects of foot and ankle.

关 键 词：旋股外侧动脉降支 嵌合穿支皮瓣 分叶穿支皮瓣 足踝部 显微外科手术 

分 类 号：R658.3[医药卫生—外科学]