逆行供血的游离股前外侧皮瓣修复儿童足踝部创面  

Free anterolateral thigh flap with reversed arterial flow in repair of foot and ankle wounds in children

作　　者：黄泽林 段梦娴 杨俊涛 李浩 朱怡 向仁堃 刘辉成 何盛茂 HUANG Zelin;DUAN Mengxian;YANG Juntao;LI Hao;ZHU Yi;XIANG Renkun;LIU Huicheng;HE Shengmao(Department of Hand&Foot Surgery,The Second Affiliated Hospital,Hengyang Medical School,University of South China,Hengyang,Hunan Province 421099,China)

机构地区：[1]南华大学衡阳医学院附属第二医院手足外科,湖南衡阳421099,长沙医学院衡阳校区护理教研室,湖南衡阳410219

出　　处：《中华显微外科杂志》2023年第2期147-151,共5页Chinese Journal of Microsurgery

基　　金：湖南省卫生健康委科研计划课题项目(C2019103)。

摘　　要：目的探讨逆行供血的游离股前外侧皮瓣(ALTF)在儿童足踝部创面修复中的可行性及临床效果。方法2014年10月至2021年2月,南华大学衡阳医学院附属第二医院手足外科采用逆行供血的游离ALTF修复儿童足踝部严重软组织损伤合并主干血管损伤的创面7例,其中车祸伤5例,机器绞伤1例,重物砸伤1例。创面大小为6.0 cm×8.0 cm~9.0 cm×11.0 cm,设计ALTF采用逆行供血方式与创面受区血管吻合,皮瓣大小为6.0 cm×8.0 cm~10.0 cm×11.0 cm,所有皮瓣供区直接拉拢缝合。分别于术后第1、3、6、12、24个月通过门诊复诊和微信、电话等方式进行随访,主要内容为皮瓣的外形、颜色、质地、感觉以及踝关节活动功能情况。结果所有皮瓣供区一期愈合,7例中5例皮瓣顺利成活;1例术后发生静脉危象,经手术探查后皮瓣成活;1例皮瓣术后发生部分坏死,予以清创后人工真皮修复。术后随访6~24个月,平均10.5个月,所有皮瓣颜色和质地与周围软组织相近,2例因皮瓣臃肿于半年后行皮瓣修整手术;按美国足踝外科协会(AOFAS)踝-后足功能评分评价踝关节功能,得分84~94分,结果优5例、良2例;参照英国医学研究会(BMRC)的标准,感觉恢复至S3+5例、S31例、S21例。结论对于足踝部严重软组织损伤合并主干血管损伤的患儿,采用逆行供血的游离ALTF修复,能有效保证血运,是临床上一种可行的创面修复方法。ObjectiveTo investigate feasibility and clinical effect of free anterolateral thigh flap(ALTF)with reversed arterial flow in repair of foot and ankle wounds in children.MethodsFrom October 2014 to February 2021,the free ALTF with reversed arterial flow was used to repair the wounds in 7 children with severe soft tissue injury and main blood vessel injury in the Department of Hand&Foot Surgery of the Second Affiliated Hospital of University of South China.Of the 7 injured children,5 were caused by traffic accident,1 by mechanical strangulation and 1 by heavy object.The size of wounds ranged from 6.0 cm×8.0 cm to 9.0 cm×11.0 cm.ALTF were designed to be anastomosed with the blood vessels at the recipient sites by retrograde blood supply.The size of flaps ranged from 6.0 cm×8.0 cm to 10.0 cm×11.0 cm.All flap donor sites were pulled together and directly sutured.Follow-ups were conducted through outpatient clinic visits,telephone call and WeChat reviews in the 1st,3rd,6th,12th and 24th months after surgery.The major contents in follow-up were the shape,colour,texture,sensation of flap and function of ankles.ResultsAll donor sites healed at I stage.A total of 5 flaps survived successfully;One flap had venous occlusion after surgery,and the flap survived after surgical exploration;One flap had partial necrosis after surgery,and repaired with artificial dermis after further debridement.Postoperative follow-up lasted for 6-24 months,with an average of 10.5 months.All flaps appeared in similar colour and texture to the surrounding soft tissues.Two children underwent flap repair after half a year due to bloated flaps.The Ankle-hind foot Function Score of American Orthopedic Foot Ankle Society(AOFAS)was used to evaluate the ankle function.AOFAS achieved 84-94 points,with 5 children in excellent and 2 in good.The sensation recovered to S 3+in 5 children,S3 in 1 child and S2 in 1 child,according to the standard of British Medical Research Council(BMRC).ConclusionFor the children with severe soft tissue injury combined with

关 键 词：股前外侧皮瓣 逆行供血 足踝 儿童 修复 

分 类 号：R726.8[医药卫生—儿科]