游离股前外侧皮瓣修复足底负重区软组织缺损的效果  

The effectiveness of free anterolateral thigh flap on repairing soft tissue defects in the plantar load-bearing area

作　　者：石玲玲[1] 吴进[1] 郭志民[1] 丁罗兵 张剑平 SHI Lingling;WU Jin;GUO Zhimin;DING Luobing;ZHANG Jianping(The 909th Hospital of Joint Logistic Support Force,Dongnan Hospital of Xiamen University,Zhangzhou 363000,China)

机构地区：[1]联勤保障部队第九O九医院、厦门大学附属东南医院骨科,福建省漳州市363000

出　　处：《组织工程与重建外科》2023年第6期541-543,548,共4页Journal of Tissue Engineering and Reconstructive Surgery

基　　金：全军后勤科研项目(20XLS21)。

摘　　要：目的探索游离股前外侧皮瓣(ALTF)修复足底负重区软组织缺损的临床效果。方法选取2020年3月至2021年3月就诊的足底负重区软组织缺损患者12例,软组织缺损范围8 cm×6 cm~26 cm×16 cm,急诊清创后用ALTF进行修复,供区创面予以直接缝合或全厚皮片植皮。结果本组12例皮瓣均成活,有2例皮瓣边缘出现少许渗出,且合并创面不愈合,经换药以及清创、抗炎等处理后自愈。术后随访6~12个月,皮瓣质地较为柔软,外观恢复情况良好。术后给予理疗以及功能康复训练,足部活动范围以及力量基本恢复正常。末次随访时患者均恢复正常步态。末期随访足底区感觉功能S1级1例(8.33%),S2级3例(25.00%),S3级6例(50.00%),S4级2例(16.67%)。术后随访第1周、第3个月及第6个月的足功能评分分别为46.25±5.27、73.14±8.42、88.74±10.51。统计分析显示Maryland足功能评分第6个月>第3个月>第1周(P<0.05)。结论对足底负重区软组织缺损行游离ALTF技术修复,临床效果较好,值得临床推广应用。Objective To explore the clinical effect of free anterolateral thigh flap(ALTF)for repairing soft tissue defects in the plantar load-bearing area.Methods From March 2020 to March 2021,12 patients with soft tissue defects in the plantar weight-bearing area were selected,the soft tissue defect ranged from 8 cm×6 cm to 26 cm×16 cm.After emergency debridement,ALTF was used to repair soft tissue defects,and the donor site wounds were directly sutured or grafted with fullthickness skin.Results All 12 flaps survived in this group,with 2 cases showing slight exudation at the edge of the flap and accompanied by non healing of the wounds.The wounds self-healed after dressing change,debridement,anti-inflammatory treatment,and other treatments.All 12 patients were followed up for 6-12 months after operation,and the skin flap texture was relatively soft and the appearance recovery was good.After operation,physical therapy and functional rehabilitation training were carried out under the guidance of medical staff,and the range of foot movement and strength were basically restored.At the last follow-up,all patients returned to normal gait.During the final follow-up,there was 1 case with S1 grade sensory function in the plantar area(8.33%),3 cases with S2 grade(25.00%),6 cases with S3 grade(50.00%),and 2 cases with S4 grade(16.67%).The postoperative foot function scores at week 1,month 3,and month 6 were 46.25±5.27,73.14±8.42 and 88.74±10.51,respectively.Statistics showed that Maryland’s foot function score in the 6th month>3rd month>1st week(P<0.05).Conclusion The use of free ALTF technology for repairing soft tissue defects in the plantar load-bearing area of patients has shown good clinical results and is worth promoting and applying in clinical practice.

关 键 词：股前外侧皮瓣 足底负重区 创面修复 感觉恢复 足踝功能 

分 类 号：R622[医药卫生—整形外科]