浅筋膜浅深交界层平面逆行分离穿支血管切取超薄股前外侧皮瓣修复足部创面  

Reconstruction of foot soft tissue defects by superthin anterolateral thigh flap harvested with retrograde dissection of the perforator in the interface plane between the superficial and deep layer of superficial fascia

作　　者：周建东 张兴飞 许同龙 杨蓊勃[2] 许亚军 陈政 陈学明 张宇轩 ZHOU Jiandong;ZHANG Xingfei;XU Tonglong;YANG Wengbo;XU Yajun;CHEN Zheng;CHEN Xueming;ZHANG Yuxuan(Department of Foot and Ankle Surgery,Wuxi Ninth People’s Hospital,Wuxi,Jiangsu Province 214062,China;Department of Orthopaedic Surgery,Nanjing First Hospital,Nanjing 210000,China)

机构地区：[1]无锡市第九人民医院足踝外科,江苏无锡214062 [2]南京市第一医院骨科,南京210000

出　　处：《中华显微外科杂志》2022年第5期515-520,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：目的探讨采用浅筋膜浅、深交界层平面逆行分离穿支血管切取超薄股前外侧皮瓣(ALTF)修复足部创面的临床疗效。方法回顾2019年8月至2021年7月,在无锡市第九人民医院足踝外科治疗的23例24侧足部损伤,男15例,女8例,年龄22~59岁,平均42岁,左侧9例,右侧13例,双侧1例,创面大小为4 cm×4 cm~11 cm×17 cm,术前采用CTA联合高频CDU定位穿支,设计超薄游离ALTF面积4 cm×5 cm~12 cm×18 cm,于浅筋膜浅、深交界层平面显露并逆行分离穿支血管,切取皮瓣修复足部创面,供区直接缝合。术后门诊与微信定期随访,评估手术效果。结果所有皮瓣均成活,2块皮瓣出现远端部分表皮坏死,皮瓣厚度3~6 mm,平均4 mm。术后随访8~16个月,平均12个月,皮瓣质地柔软无破损,2块皮瓣需要二期削薄,其余皮瓣外观满意,无臃肿畸形,供区仅遗留线形瘢痕。结论浅筋膜浅、深交界层平面逆行分离穿支血管切取超薄ALTF修复足部创面效果可靠,可获得满意的外观和功能。Objective To investigate the clinical effect of superthin anterolateral thigh flap(ALTF)with retrograde dissection of perforator in the interface plane between the superficial and deep layer of superficial fascia for reconstruction of soft tissue defect in the foot.Methods The study involved 24 Side of 23 patients with foot soft tissue defects in Department of Foot and Ankle Surgery in Wuxi Ninth People’s Hospital from August 2019 to July 2021.There were 15 males and 8 females with an average of 42(range,22-59)years old,including 9 in left foot,13 in right foot,and 1 in both feet.The size of soft tissue defects was 4 cm×4 cm-11 cm×17 cm.The dimension of the superthin ALTF was 4 cm×5 cm-12 cm×18 cm.CTA and high-frequency CDU were used to locate the perforator in the superficial fascia plane.The perforator was exposed and dissected retrograde in the adiposal layer.The superthin ALTF was harvested to repair the foot wound.The donor site was sutured directly.All patients enter follow-up reviews at outpatient clinic or by WeChat.The appearance of flaps were recorded.Results The superthin ALTF survived in all patients.Two cases had partial epidermal necrosis at the distal part of the flap.The thickness of the flap averaged approximately 4(range 3-6)mm.During 8-16(mean 12)months of follow-up,all superthin ALTF were soft in texture without ulceration.Two flaps required secondary defatting procedures,others showed satisfactory appearance without bulky deformity.Only linear scars left in donor areas.Conclusion The technique of harvesting superthin ALTF with retrograde dissection of perforator in the superficial fascia plane for repairing foot wounds is reliable and is able to achieve satisfactory functional and esthetic outcome.

关 键 词：股前外侧皮瓣 超薄皮瓣 穿支定位 足部创面 显微外科技术 

分 类 号：R658.3[医药卫生—外科学]