双边多三角形对顶设计旋股外侧动脉降支穿支皮瓣移植修复手前臂软组织缺损  

Application of descending branch of lateral circumflex femoral artery perforator flap designed with multiple triangles in opposite position of the bilateral flap sides in repair of hand and forearm soft tissue defects

作　　者：于胜军 马振杰 李晓 付胜强 李英 王志龙 徐俊涛 Yu Shengjun;Ma Zhenjie;Li Xiao;Fu Shengqiang;Li Ying;Wang Zhilong;Xu Juntao(Department of Hand Surgery,Yantaishan Hospital,Yantai 264001,China)

机构地区：[1]烟台山医院手外科,烟台264001

出　　处：《中华手外科杂志》2023年第2期125-128,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨双边多三角形对顶设计旋股外侧动脉降支穿支皮瓣移植修复手前臂软组织缺损的应用方法及效果。方法自2019年2月至2021年6月,我科应用双边多三角形对顶设计旋股外侧动脉降支穿支皮瓣移植修复手前臂软组织缺损患者9例,均伴有不同程度的骨与关节或肌腱等深部组织外露。均于大腿切取旋股外侧动脉降支穿支皮瓣。皮肤缺损面积为18 cm×9 cm~22 cm×10 cm,术前根据受区创面的形状,在皮瓣纵轴双边设计多个对顶三角形,两侧三角尽量彼此交错分布,尽量避免三角形顶部与穿支在同一平面,皮瓣切取面积为23.0 cm×9.5 cm~28.0 cm×10.0 cm。皮瓣移植修复前臂手部创面,吻合供区与受区血管,重建皮瓣血运。供区均直接闭合。术后观察临床疗效。结果术后9例皮瓣全部存活,无血管痉挛及危象发生,皮瓣切取宽度为9.5~10.0 cm,供区创面均能直接拉拢缝合。术后随访10~32个月,平均18个月。皮瓣供区线性瘢痕愈合,无裂开及伤口周围皮缘坏死现象,无肌疝发生,皮瓣质地柔软,弹性好,肤色接近正常皮肤,其中2例皮瓣略显臃肿,术后半年进行二次整形。患侧手关节屈伸功能满意。同侧膝关节活动好。结论采用双边多三角形对顶设计旋股外侧动脉降支穿支皮瓣移植修复手前臂软组织缺损,能最大程度地减轻供区缝合张力,尤其对于切取宽度小于10 cm的皮瓣供区,能实现供区一期闭合,具有临床推广价值。Objective To investigate the method and clinical efficacy of descending branch of lateral circumflex femoral artery perforator flap designed with multiple triangles in opposite position of the bilateral flap sides in repair of hand and forearm soft tissue defects.Methods From February 2019 to June 2021,9 patients with forearm soft tissue defects were treated with descending branch of lateral circumflex femoral artery perforator flap designed with multiple triangles in opposite position of the bilateral flap sides.All the patients were accompanied by exposure of bone,joint or tendon and other deep tissues.The descending branch of lateral circumflex femoral artery perforator flapwas cut from the thigh.The area of skin defect was 18 cm×9 cm to 22 cm×10 cm.According to the shape of the wound in the recipient area,several opposite triangles were designed on both sides of the longitudinal axis of the flap before operation.Triangles on both sides should be staggered as far as possible to avoid that the top of the triangle and the perforator are in the same plane.The area of the flap was 23.0 cm×9.5 cmto 28.0 cm×10.0 cm.The skin flap was transplanted to repair the forearm and hand wound,the blood vessels of the donor and recipient areas were anastomosed,and the blood supply of the skin flap was reconstructed.The donor areas are directly closed.The clinical efficacy was observed after operation.Results All the 9 flaps survived without vasospasm and crisis.The width of the flaps was 9.5 to 10.0 cm.The wounds in the donor area could be directly sutured.The patients were follow-up for 10 to 32 months,with an average of 18 months.The linear scar in the donor area of the flap healed,without split and necrosis of the skin margin around the wound,without occurrence of muscle hernia.The flap was soft and elastic,and its skin color was close to normal skin.Two of the flaps were slightly swollen,and secondary plastic surgery was carried out half a year after the operation.The flexion and extension function of the affected hand

关 键 词：外科皮瓣 显微外科手术 旋股外侧动脉降支 修复 缺损 

分 类 号：R658.2[医药卫生—外科学]