穿支位置与穿支穿深筋膜后走行方式对股前外侧皮瓣发生部分坏死的影响初探  

A preliminary study on the effect of the location of the perforator branch and the route of the perforator branch through the deep fascia on the partial necrosis of the anterolateral thigh flap

作　　者：高钦锋 杨林[2] 黄永涛 杨成鹏 孙丰文 曹阳 刘禹城 张岩 程俊楠 张韬 巨积辉[2] Qinfeng Gao;Lin Yang;Yongtao Huang;Chengpeng Yang;Fengwen Sun;Yang Cao;Yucheng Liu;Yan Zhang;Junnan Cheng;Tao Zhang;Jihui Ju(Department of Hand Surgery,Suzhou Ruihua Orthopaedic Hospital,Suzhou 215104,China;Suzhou Medical College of Soochow University,Suzhou 215123,China)

机构地区：[1]苏州瑞华骨科医院手外科,215104 [2]苏州大学苏州医学院,215123

出　　处：《中华损伤与修复杂志（电子版）》2024年第2期141-146,共6页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：苏州市姑苏卫生人才计划项目(GSWS2020116);苏州市重点病种诊疗技术专项项目(LCZX202026);苏州市重点学科(SZXK202127);苏州市吴中区科技计划项目(医疗卫生领域)(WZYW2021001)。

摘　　要：目的探讨穿支位置与穿支穿深筋膜后走行方式对股前外侧皮瓣发生部分坏死的影响。方法回顾性研究苏州瑞华骨科医院手外科2018年10月至2021年6月采用游离股前外侧皮瓣修复四肢创面术后皮瓣发生部分坏死的25例患者资料,同时在同一时期内随机选择25例采用股前外侧皮瓣修复创面皮瓣完全成活患者。对比分析两组年龄、性别、穿支类型、穿支距皮缘距离、穿支位置设计与穿支穿深筋膜后走行方式的一致性、皮瓣切取时间、皮瓣大小的差异,探索股前外侧皮瓣发生部分坏死的原因。结果皮瓣部分坏死组和皮瓣完全成活组年龄、性别、穿支类型、穿支距皮缘距离、皮瓣切取时间、皮瓣大小差异无统计学意义(P>0.05),两组穿支位置设计是否与穿支深筋膜后走行一致的例数差异有统计学意义(P=0.001)。将其进行logistic回归分析显示,穿支位置设计与穿支穿深筋膜后走行方式是否一致为皮瓣部分坏死的影响因素(OR=38.812,P<0.001)。结论穿支位置设计与穿支穿深筋膜后走行方式是否一致是影响皮瓣发生部分坏死的原因。根据穿支穿深筋膜后走行方式及穿支位置设计皮瓣,可降低皮瓣发生部分坏死的概率。Objective To investigate the influence of the location of the perforator branch and the route of the perforator branch through the deep fascia on the partial necrosis of the anterolateral thigh flap.Methods A retrospective study was conducted on 25 patients with partial necrosis of skin flap after limb wound repair with free anterolateral thigh flap at the Department of Hand Surgery,Suzhou Ruihua Orthopaedic Hospital from October 2018 to June 2021.At the same time,25 patients with no necrosis of anterolateral thigh flap were randomly selected.The age,sex,the type of perforator,the distance between the perforator and the edge of the skin,the consistency between the design of the position of the perforator branch and the pattern of the perforator branch after penetrating the deep fascia,the cutting time of the flap and the size of flap were compared and analyzed between the two groups.Data were analyzed by t-test,chi-square test and logistic regression analysis.Results There was no significant difference in age,sex,type of perforator,distance from perforator to skin margin,flap removal time and flap size between the two groups(P>0.05).There was a significant difference in the number of cases in which the location of the perforator branch was consistent with the direction of the deep fascia of the perforator branch between the two groups(P=0.001).Logistic regression analysis showed that whether the location design of the perforator branch was consistent with the route of the perforator branch after penetrator the deep fascia was the influencing factor of partial necrosis of the skin flap(OR=38.812,P<0.001).Conclusion Whether the design of the position of the perforator branch is consistent with the way of the perforator branch after penetrator the deep fascia is the reason that affects the partial necrosis of the skin flap.The probability of partial necrosis of the flap can be reduced by designing the flap according to the ascending mode of the perforator branch after penetracting the deep fascia and the position of

关 键 词：穿支皮瓣 股前外侧皮瓣 部分坏死 入皮方式 皮瓣设计 

分 类 号：R658.2[医药卫生—外科学]