以膝降动脉为蒂的游离股前外侧穿支皮瓣修复小腿保肢术后创面的临床效果  

Clinical effects of free anterolateral thigh perforator flap pedicled with descending genicular artery in repairing wounds after lower leg limb-sparing surgery

作　　者：李雷 周正虎 鞠文 邓伟 陈鲁成 李昌松 夏宇航 巨积辉 Li Lei;Zhou Zhenghu;Ju Wen;Deng Wei;Chen Lucheng;Li Changsong;Xia Yuhang;Ju Jihui(Department of Orthopaedics Trauma,Suzhou Ruihua Orthopedic Hospital,Suzhou 215104,China)

机构地区：[1]苏州瑞华骨科医院创伤骨科,苏州215104

出　　处：《中华烧伤与创面修复杂志》2023年第5期450-455,共6页Chinese Journal of Burns And Wounds

基　　金：苏州市卫生科教临床重点病种诊疗技术专项(LCZX202130)。

摘　　要：目的探讨以膝降动脉为蒂的游离股前外侧穿支皮瓣修复小腿保肢术后创面的临床效果。方法采用回顾性观察性研究方法。2019年1月—2021年6月,苏州瑞华骨科医院收治12例符合入选标准的小腿保肢术后创面患者,其中男6例、女6例,年龄17~74岁,原始创面面积为17 cm×9 cm~40 cm×15 cm,5例患者创面有感染。创面均采用对侧游离大腿股前外侧穿支皮瓣(面积为18 cm×10 cm~37 cm×9 cm)修复,皮瓣动脉均吻合于膝降动脉,供区创面直接缝合;7例患者另移植对侧大腿刃厚皮片覆盖皮瓣无法覆盖的剩余创面,供区创面予油纱覆盖。术中记录皮瓣携带的穿支类型、受区动静脉类型。术后记录皮瓣成活和血管危象发生情况、皮片成活情况、供受区创面愈合情况、皮瓣移植术后患者住院时间。随访记录皮瓣色泽和质地、小腿再次感染情况及骨折愈合情况。末次随访时根据陈中伟断肢再植的功能评定标准评价患者的保肢效果。结果皮瓣携带的穿支类型:仅携带旋股外侧动脉降支者6例,仅携带旋股外侧动脉斜支者3例,携带旋股外侧动脉降支+旋股外侧动脉斜支并吻合穿支进行内增压者3例。皮瓣受区动脉类型:膝降动脉主干者1例,膝降动脉隐支者8例,膝降动脉关节支者3例;受区静脉类型:1条膝降动脉伴行静脉+1条大隐静脉分支者8例、2条大隐静脉分支者4例。术后皮瓣均成活且无血管危象,皮片也均成活;供受区创面均愈合。皮瓣移植术后患者住院时间为13~79 d。随访6~23个月,12例患者皮瓣色泽、质地均良好,小腿创面均无感染;5例患者术后骨折愈合后去除内/外固定,7例患者术后骨折未愈合再次行植骨内固定后切口均愈合无感染。末次随访时,患者的保肢效果评价:优者7例、良者4例、可者1例。结论以膝降动脉为蒂的游离股前外侧穿支皮瓣可有效修复小腿保肢术后创面、控制感染,不增加远端肢�Objective To explore the clinical effects of free anterolateral thigh perforator flap pedicled with descending genicular artery in repairing wounds after lower leg limb-sparing surgery.Methods A retrospective observational study was conducted.From January 2019 to June 2021,12 patients with wounds after lower leg limb-sparing surgery who met the inclusion criteria were admitted to Suzhou Ruihua Orthopedic Hospital,including 6 males and 6 females,aged 17 to 74 years,with original wound area ranging from 17 cm×9 cm to 40 cm×15 cm.Five patients had infection in wounds.The wounds were all repaired by free anterolateral thigh perforator flap from contralateral thigh,with area of 18 cm×10 cm to 37 cm×9 cm.The artery of flap was anastomosed with the descending genicular artery,and the wounds in donor areas were sutured directly.Seven patients were transplanted with split-thickness skin grafts from the contralateral thigh to cover the remaining wounds that can not be covered by flap and the wounds in donor areas were covered with gauze.During the operation,the types of perforating branch carried by flap and the types of arteries and veins in recipient areas were recorded.The survival and occurrence of vascular crisis of flap,the survival of skin graft,the wound healing in donor and recipient areas,and the length of hospital stay after flap transplant surgery were recorded.During follow-up,the color and texture of flap,reinfection in lower leg,and fracture healing were recorded.At the last follow-up,the limb salvage function of patients was evaluated according to the functional evaluation criteria of Chen Zhongwei's amputated limb replantation.Results The types of perforating branches carried by flaps were as follows:6 cases of only carrying the descending branch of the lateral circumflex femoral artery,3 cases of only carrying the oblique branch of the lateral circumflex femoral artery,and 3 cases of carrying the descending branch of the lateral circumflex femoral artery and oblique branch of the lateral circumflex fe

关 键 词：外科皮瓣 腿损伤 膝降动脉 股前外侧穿支皮瓣 创面修复 

分 类 号：R658.3[医药卫生—外科学]