游离双侧股前外侧皮瓣串联修复前臂大面积软组织缺损  

Repair the large area soft tissue defect of forearm with free bilateral anterolateral thigh flaps in series

作　　者：刘丰[1] 李健[1] 毛幸 蓝益南 江洵 刘舜平 吴凌峰[1] 蔡晓斌 王欣[2] LIU Feng;LI Jian;MAO Xing;LAN Yinan;JIANG Xun;LIU Shunping;WU Lingfeng;CAI Xiaobin;WANG Xin(Department of Plastic(Repair and Reconstruction)Surgery,Lishui Hospital of Zhejiang University,Lishui,Zhejiang Province 323000,China;Department of Hand Microsurgery&Plastic Surgery,Ningbo Sixth Hospital,Ningbo,Zhejiang Province 315000,China)

机构地区：[1]浙江大学丽水医院整形(修复重建)外科,浙江丽水323000 [2]宁波市第六医院手显微外科与整复外科,浙江宁波315000

出　　处：《中华显微外科杂志》2022年第5期539-543,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨应用游离双侧股前外侧皮瓣(ALTF)串联修复前臂大面积软组织缺损的临床疗效。方法回顾性分析2014年3月至2021年12月浙江大学丽水医院整形(修复重建)外科收治前臂大面积软组织缺损11例患者的临床资料,其中男8例,女3例。年龄36~68岁,平均48岁。创面清创后行VSD处理,术后3~5 d拆除VSD装置,创面新鲜后采用游离双侧ALTF串联修复。前臂创面大小18 cm×15 cm~28 cm×13 cm,单个皮瓣切取的面积10 cm×8 cm~20 cm×13 cm。双侧皮瓣的串联:其中一侧皮瓣作为近端皮瓣,其血管蒂与受区动、静脉相吻合,另一侧皮瓣作为远端皮瓣,将两块ALTF之间的动、静脉相吻合。远端皮瓣以远的血管蒂结扎或者与尺动脉远端或桡动脉的远端相吻合。皮瓣与受区周围皮肤作间断缝合。皮瓣供区均同期直接闭合。术后定期、规律门诊随访并分析临床疗效。结果术后皮瓣均顺利成活,随访时间为6~18个月,平均12个月,皮瓣成活良好,质地柔软,不臃肿,毛细血管反应时间正常,色泽红润,表面无破溃,恢复了保护性感觉。患肢手部功能恢复良好。供区切口愈合良好,无并发症发生。末次随访采用中华医学会手外科学会上肢功能评定试用标准对患肢手部功能进行评定:7例为优,4例为良;对患者进行皮瓣及治疗效果的满意度调查,均为满意。结论利用游离双侧ALTF串联可修复创面的面积大,且供区可一期闭合,是修复前臂大面积软组织缺损可推广的有效方法。Objective To investigate the clinical effect of using free bilateral anterolateral thigh flaps(ALTF)in series to repair large area soft tissue defects of forearm.Methods The clinical data of 11 patients with large soft tissue defects of forearm admitted in the Department of Plastic(Repair and Reconstruction)Surgery,Lishui Hospital of Zhejiang University from March 2014 to December 2021 were retrospectively analyzed,including 8 males and 3 females.Aged 36 to 68 years old,with an average of 48 years old.VSD treatment was performed after debridement,and until fresh removed 3 to 5 days after the operation.Until the wound was fresh.The wound was repaired with free bilateral ALTF in series until fresh.The size of the forearm wound was 18 cm×15 cm-28 cm×13 cm.The cut area of a single flap was 10 cm×8 cm-20 cm×13 cm.The series of bilateral flaps:One of the flaps was used as the proximal flap,and its vascular pedicle was anastomosed with the arteries and veins of the recipient area.The other flap was used as the distal flap,and the arteries and veins between the 2 ALTFs on both sides were anastomosed.The vascular pedicle beyond the distal flap was ligated or anastomosed to the distal end of the ulnar artery or the distal end of the radial artery.The flap and the surrounding skin of the recipient area were sutured immediately.The donor sites of the flap was closed directly.Periodic and regular outpatient follow-up was performed after operation and the clinical efficacy was analyzed.Results All the flaps successfully survived after the surgery.The postoperative follow-up lasted for 6-18 months,12 months in average.The flaps survived well with good soft texture,without swelling,the capillary reaction time was normal,without surface ulceration,in rosy colour and restored protective sensations.The hand function of the affected limb recovered well.The wound at donor sites healed well without complications.At the last follow-up,the hand function of the affected limb was evaluated by the Evaluation Trial Standards of Upper Li

关 键 词：股前外侧皮瓣 前臂 大面积软组织缺损 修复 显微外科技术 

分 类 号：R658.2[医药卫生—外科学]