Flow-through桥式股前外侧皮瓣修复复杂小腿软组织缺损  

Clinical application of Flow-through bridge anterolateral thigh flap in repair of complex calf softtissue defects

作　　者：周洪翔[1] 钟林[1] 何亮 黄俊[1] 周涛[1] 周定[1] 王子富 尹东 金哲 牛杨 周昱扬 ZHOU Hongxiang;ZHONG Lin;HE Liang;HUANG Jun;ZHOU Tao;ZHOU Ding;WANG Zifu;YIN Dong;JIN Zhe;NIU Yang;ZHOU Yuyang(Microscopic Repair and Reconstruction and Foot and Ankle Ward,the First Affiliated Hospital of Anhui Medical University,Hefei Anhui,230022,P.R.China;AnqingMedical College,Anqing Anhui,246052,P.R.China)

机构地区：[1]安徽医科大学第一附属医院显微修复重建及足踝病区,合肥230022 [2]安庆医药高等专科学校,安徽安庆246052

出　　处：《中国修复重建外科杂志》2023年第4期482-487,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：安徽省教育厅基金项目(2022AH0511511)。

摘　　要：目的探讨Flow-through桥式股前外侧皮瓣修复复杂小腿软组织缺损的疗效。方法回顾分析2008年1月—2022年1月采用Flow-through桥式股前外侧皮瓣(研究组,23例)或单纯桥式股前外侧皮瓣(对照组,23例)治疗的复杂小腿软组织缺损患者临床资料。所有患者缺损均为外伤或骨髓炎所致,小腿仅存1根主要血管或者没有与移植皮瓣吻合的血管。两组患者性别、年龄、致伤原因、小腿软组织缺损范围及受伤至手术时间等一般资料比较差异均无统计学意义(P>0.05)。术后采用下肢功能评价量表(LEFS)评价两组患者患侧下肢功能,参照中华医学会手外科学会断肢再植功能评定试用标准评价健侧下肢末梢血液循环状态,采用Weber定量法检测静态两点辨别觉(static 2-point discrimination,S2PD)评价健侧下肢末梢感觉,并比较两组患者健侧腘动脉血液流速、趾甲毛细血管充盈时间、足部温度、足趾血氧饱和度及并发症发生情况。结果术中未发生血管及神经损伤。两组各发生1例皮瓣部分坏死,经游离植皮后愈合;其余皮瓣完全成活。46例患者均获随访,随访时间6个月~8年,中位时间26个月。两组患者患侧肢体功能恢复满意,皮瓣血运良好、质地柔软、外观尚可;供区切口仅留一线性瘢痕,植皮区色泽与周围正常皮肤相近,取皮处可见一长方形瘢痕,外观满意。健侧远端肢体血运良好,色泽及皮温未见明显异常,活动时肢体血液供应无异常。术后1个月断蒂后研究组健侧腘动脉血液流速快于对照组,足部温度、足趾血氧饱和度、S2PD、趾甲毛细血管充盈时间、末梢血液循环评分均优于对照组(P<0.05)。术后对照组发生健侧足部冰凉8例、麻木2例,研究组仅发生3例足部冰凉,研究组并发症发生率(13.04%)明显低于对照组(43.47%)(χ^(2)=3.860,P=0.049)。术后6个月两组患侧LEFS评分比较差异无统计学意义(P>0.05)。结论Flow-through桥�Objective To investigate the effectiveness of Flow-through bridge anterolateral thigh flap transplantation in the treatment of complex calf soft tissue defects.MethodssThe clinical data of the patients with complicated calf soft tissue defects,who were treated with Flow-through bridge anterolateral thigh flap(study group,23 cases)or bridge anterolateral thigh flap(control group,23 cases)between January 2008 and January 2022,were retrospectively analyzed.All complex calf soft tissue defects in the two groups were caused by trauma or osteomyelitis,and there was only one major blood vessel in the calf or no blood vessel anastomosed with the grafted skin flap.There was no significant difference between the two groups in general data such as gender,age,etiology,size ofleg soft tissue defect,and time from injury to operation(P>0.05).The lower extremity functional scale(LEFS)was used to evaluate the sufferred lower extremity function of the both groups after operation,and the peripheral blood circulation score of the healthy side was evaluated according to the Chinese Medical Association Hand Surgery Society's functional evaluation standard for replantation of amputated limbs.Weber's quantitative method was used to detect static 2-point discrimination(S2PD)to evaluate peripheral sensation of the healthy side,and the popliteal artery flow velocity,toenail capillary filling time,foot temperature,toe blood oxygen saturation of the healthy side,and the incidence of complications were compared between the two groups.ResultsNo vascular or nerve injury occurred during operation.All flaps survived,and 1 case of partial flap necrosis occurred in both groups,which healed after free skin grafting.All patients were followed up 6 months to 8 years,with a median time of 26 months.The function of the sufferred limb of the two groups recovered satisfactorily,the blood supply of the flap was good,the texture was soft,and the appearance was fair.The incision in the donor site healed well with a linear scar,and the color of the skin graft

关 键 词：桥式皮瓣 股前外侧皮瓣 Flow-through技术 复杂小腿软组织缺损 

分 类 号：R622[医药卫生—整形外科]