以旋股外侧动脉降支为蒂的股前外侧穿支皮瓣串联修复下肢大面积软组织缺损  

Reconstruction of large soft tissue defects in lower limbs with bilateral anteriolateral thigh perforator flaps pedicled with descending branch of lateral circumflex femoral artery in series

作　　者：王正丹 任胜全 吴彩风 刘春雷 汪建 曹振鲁 丁小珩[1] WANG Zhengdan;REN Shengquan;WU Caifeng;LIU Chunlei;WANG Jian;CAO Zhenlu;DING Xiaoheng(Department of Hand and Foot Microsurgery,the Affiliated Hospital of Qingdao University,Qingdao,Shandong Province 266000,China)

机构地区：[1]青岛大学附属医院手足显微外科,山东青岛266000

出　　处：《中华显微外科杂志》2023年第6期666-671,共6页Chinese Journal of Microsurgery

基　　金：青岛市惠民科技计划项目(21-1-4-rkjk-2-nsh)。

摘　　要：目的探讨应用以旋股外侧动脉降支为蒂的股前外侧穿支皮瓣(ALTPF)串联修复下肢大面积软组织缺损的临床疗效。方法选取2018年6月-2023年1月青岛大学附属医院手足显微外科治疗的下肢大面积软组织缺损患者9例,男6例,女3例;年龄18~57岁;伤因:车祸伤4例,碾压伤2例,高处坠落2例,爆炸伤1例;小腿并足背软组织缺损5例,小腿胫前、胫后软组织缺损伴胫骨骨折4例。所有患肢均存在不同程度的组织坏死、感染,合并肌腱、神经、骨、关节等深部组织缺损或植入物外露,软组织缺损面积30 cm×14 cm~42 cm×14 cm,均采用以双侧旋股外侧动脉降支为蒂的ALTPF串联修复,近端皮瓣大小25 cm×8 cm~33 cm×13 cm,远端皮瓣大小20 cm×7 cm~29 cm×13 cm。术后定期随访,观察移植皮瓣成活情况及小腿及足部功能恢复情况,参照英国医学研究会(BMRC)标准评定皮瓣感觉恢复,并按照Puno评分标准来评价功能恢复情况,分析其临床效果。结果9例皮瓣均成活,切口愈合良好,1例术后24 h内出现血管危象,及时手术探查后好转,皮瓣远端发生小面积的坏死,经二期植皮创面愈合。术后随访平均8.3个月,2例因皮肤臃肿二期行皮瓣修薄,2例小腿皮瓣稍显臃肿,其余5例皮瓣外形无明显臃肿,缝接股外侧皮神经给予神经重建患者共2例,末次随访时,9例按照BMRC标准,感觉恢复至S2~S3+。功能恢复按Puno评分为(88.36±5.36)分,优4例,良3例,可2例。结论应用以旋股外侧动脉降支为蒂的ALTPF串联修复下肢大面积软组织缺损具有较好的临床应用价值,是有效的修复手段之一。Objective To investigate the clinical effect of bilateral anteriolateral thigh perforator flaps(ALTPF)pedicled with descending branch of lateral circumflex femoral artery in series on reconstruction of large soft tissue defects in lower limbs.Methods A total of 9 patients with large soft tissue defects in lower limbs were selected in the study.The patients were 6 males and 3 females aged between 18 and 57 years old.They were treated in the Department of Hand and Foot Microsurgery,the Affiliated Hospital of Qingdao University from June 2018 to January 2023.Causes of injury:4 of traffic accident,2 of crushing,2 of falling from height and 1 of explosion.Five patients had combined defects in dorsal feet and 4 with tibia fractures and anterior-and-posterior-tibial soft tissue defects.All affected limbs had tissue necroses and infections in various degrees.Deep tissue defects such as tendons,nerves,bones and joints or orthopaedic implants were exposed.The areas of soft tissue defects were 30 cm×14 cm-42 cm×14 cm.All the defects were reconstructed by the bilateral ALTPF pedicled with descending branch of lateral circumflex femoral artery in series.The size of proximal flaps was 25 cm×8 cm-33 cm×13 cm and 20 cm×7 cm-29 cm×13 cm for the distal flaps.Scheduled postoperative follow-ups were conducted to observe the survival of the transferred flaps and functional recovery of calfs and feet.Sensory recovery was assessed against British Medical Research Council(BMRC)criteria.Puno scoring was used to assess the functional recovery and the effectiveness of treatment.Results All flaps survived and the donor sites healed well.One patient developed vascular compromise within 24 hours after surgery,but it was rectified after timely surgical exploration,however it left with a small area of necrosis at distal end of the flap.The necrosis and wound healed after skin grafting in stage-two surgery.Postoperative follow-up lasted for 8.3 months in average.Two patients underwent flap thinning in stage-two surgery due to bloating appe

关 键 词：旋股外侧动脉降支 股前外侧穿支皮瓣 下肢 软组织缺损 创面修复 显微外科技术 

分 类 号：R658.3[医药卫生—外科学]