应用横行切口进行端侧吻合的股前外侧皮瓣修复四肢大关节周围软组织缺损  

Clinical Effect of Anterolateral Thigh Flap with End to Side Anastomosis Through Transverse Incision in Repairing Soft Tissue Defects Around Large Joints of Extremities

作　　者：杨辰[1] 王振中 刘路 殷耀斌[1] 杨勇[1] YANG Chen;WANG Zhenzhong;LIU Lu;YIN Yaobin;YANG Yong(Department of Hand Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院手外科,北京100035

出　　处：《中国美容医学》2023年第2期56-60,共5页Chinese Journal of Aesthetic Medicine

基　　金：北京市卫生和计划生育委员会,北京市卫生系统高层次卫生技术人才培养计划(编号:2015-3-036)。

摘　　要：目的:探讨采用横行切口进行血管端侧吻合的股前外侧皮瓣修复四肢大关节周围大面积软组织缺损的临床疗效。方法:选择2017年6月-2021年3月笔者科室收治的15例因瘢痕或肿瘤切除后四肢大关节周围大面积软组织缺损的患者为研究对象,术前多普勒超声确定皮瓣穿支部位,术中测量关节周围软组织缺损面积为7 cm×13 cm~10 cm×23 cm,均采用游离股前外侧皮瓣移植修复软组织缺损。皮瓣血管与主干血管进行端侧吻合,将吻合口的切口方向从以往的纵行切口改为横行切口,以减少主干血管的损伤并利于吻合。术后定期随访12~26(18.7±3.4)个月,记录皮瓣愈合情况、关节功能、皮瓣供区愈合情况、血管吻合处的B超检查结果。结果:术后皮瓣全部成活,皮瓣供区均愈合,均未发生血管或皮瓣相关并发症;术后1个月、3个月和12个月随访时各关节的总主动活动度(TAM)分别为(45.33±22.31)°、(64.33±27.04)°和(76.67±32.66)°,术后时间越长,关节活动度越好,差异有统计学意义(P<0.05)。术后12个月,患侧TAM为健侧的65.47%,关节活动功能改善满意;皮瓣疗效满意度评定,总分6~9分,平均6.8分,疗效均为满意;术区血管B超检查,所有主干动脉和皮瓣营养动脉血流通畅,皮瓣动脉管径(1.72±0.14)mm,血液流速(11.5±1.6)cm/s。结论:应用横行切口进行端侧吻合的股前外侧皮瓣移植治疗四肢大关节周围大面积软组织缺损,可减少受区组织损伤、降低血管吻合难度,皮瓣成活率高,术后肢体功能恢复良好,为四肢大关节周围软组织缺损的修复提供了一种可靠易行的方案。Objective To investigate the clinical effect of anterolateral femoral flap with transverse incision for end-to-side anastomosis in the repair of large soft tissue defects around the large joint of the extremities. Methods From June 2017 to March 2021,15 patients with large soft tissue defects around large joints of limbs after scar or tumor resection were admitted to our department.Doppler ultrasound was used to determine the location of the perforating branch preoperatively.The sizes of soft tissue defect were from 7 cm×13 cm to 10 cm×23 cm intraoperatively,and the defect was repaired by free anterolateral femoral flap.In order to reduce the damage of main blood vessels and facilitate anastomosis,the flap vessels were anastomosed to the main blood vessels by end-to-side anastomosis,with the incision direction of main blood vessels changed from longitudinal to transverse direction.Regular follow-up was performed to record the flap healing,joint function,donor site healing,and the results of ultrasound examination of the vessels. All patients were followed up for 12 ~ 26(18.7±3.4) months. Results All the flaps survived,the donor sites of flaps healed well,and no vascular or flap-related complications occurred.The total active motion(TAM) at 1,3 and 12 months after operation were(45.33±22.31)°,(64.33±27.04)° and(76.67±32.66)°,respectively.The longer the following time,the better the TAM,the difference was statistically significant(P<0.05). 12 months after operation,TAM of the affected side was 65.47% of that of the healthy side,with a good joint function.The satisfaction score of flap was evaluated with a total score of 6-9 points and an average of 6.8 points.Ultrasonography was performed,all the main arteries and nutrient arteries of the flap have good blood flow. The arterial diameter of the flap was(1.72±0.14) mm,and the blood flow velocity was(11.5±1.6) cm/s. Conclusion Application of femoral anterolateral flap transplantation,with transverse incision of the main vessels,can reduce tissue damage,faci

关 键 词：股前外侧皮瓣 移植 软组织缺损 血管吻合 显微外科手术 创面修复 

分 类 号：R622[医药卫生—整形外科]