显微修薄的股前外侧皮瓣在肢体肿瘤整形外科治疗中的应用  

The application of microsurgical thinning of the anterolateral thigh flap in plastic surgery for treating limb tumors

作　　者：郑大伟 黎章灿 裴广楠 方杰 潘勇 石荣剑 周晓[2] Zheng Dawei;Li Zhangcan;Pei Guangnan;Fang Jie;Pan Yong;Shi Rongjian;Zhou Xiao(Microsurgery and Reconstruction Department,Xuzhou Renci Hospital,Xuzhou 221004,China;Department of Oncology and Plastic Surgery,Hunan Cancer Hospital,Changsha 410013,China)

机构地区：[1]徐州仁慈医院显微修复重建外科,徐州221004 [2]湖南省肿瘤医院肿瘤整形外科,长沙410013

出　　处：《中华整形外科杂志》2024年第6期626-633,共8页Chinese Journal of Plastic Surgery

基　　金：2021年徐州市推动科技创新专项资金重点研发计划项目(KC21232)。

摘　　要：目的探讨显微修薄优化的股前外侧皮瓣在肢体肿瘤切除后创面修复中的应用效果。方法回顾性分析2019年1月至2021年1月徐州仁慈医院显微修复重建外科收治的肢体肿瘤患者临床资料。患者均于手术规范切除肿瘤病灶后,采用显微修薄优化的股前外侧皮瓣修复创面。术后门诊随访,术后1年参照美国肌肉骨骼肿瘤协会(MSTS)骨肿瘤保肢术后肢体功能量表评定患肢功能,满分为30分,评分越高表示功能越佳;采用效果满意度评分量表对肢体外观进行评价,总分5~10分为满意,0~4分为一般,-5~-1分为不满意。采用描述性方法进行统计分析,正态分布计量资料以±s表示。结果共纳入11例患者,男7例,女4例,年龄19~55岁,平均31.5岁。其中,隆突性皮肤纤维肉瘤3例,侵袭性纤维瘤4例,黏液性纤维肉瘤1例,恶性纤维组织细胞瘤2例,皮肤鳞状细胞癌1例。肿瘤病变范围5.5 cm×8.0 cm~9.0 cm×19.0 cm,术中切除肿瘤范围6.5 cm×9.0 cm~10.0 cm×20.0 cm,切取皮瓣面积7.5 cm×11.0 cm~10.0 cm×22.5 cm,皮瓣修薄前平均厚度2.2 cm(1.6~3.5 cm),修薄后平均厚度1.2 cm(0.9~1.7 cm)。术后1例皮瓣边缘出现1.5 cm×2.0 cm浅表坏死,经换药后伤口延期愈合;1例术后48 h出现动脉危象,探查见吻合口远端有血栓形成,予重新吻合后血运恢复;其余皮瓣均成活良好,切口一期愈合。术后随访12~18个月,平均14.5个月,肿瘤无复发,患肢功能MSTS评分为(25.2±2.1)分,肢体外观效果满意度评分为(7.4±1.6)分,满意率为10/11。结论在肢体肿瘤整形外科治疗中,应用显微修薄优化的股前外侧皮瓣修复肿瘤规范切除后创面,可恢复满意的肢体功能与外观,是较理想的手术方法。Objective To explore the application effect of microsurgical thinning optimized anterolateral thigh flap in the repair of limb tumor wounds.Methods A retrospective analysis was conducted on the clinical data of patients with limb tumors at the Microsurgery and Reconstruction Department of Xuzhou Renci Hospital from January 2019 to January 2021.All patients underwent surgical resection of the lesions and were repaired with microsurgical thinning optimized anterolateral thigh flap.The outpatient follow-up was conducted after surgery.One year after surgery,limb function and appearance were evaluated using the Musculoskeletal Tumor Society(MSTS)bone tumor limb salvage surgery limb energy scale and efficacy satisfaction score.The total score is 30 points,and a higher score indicates better function.The limb appearance was evaluated using a satisfaction score scale,with a total score of 5-10 points being satisfactory,0-4 points being average,and-5 to-1 points considered unsatisfactory.Descriptive methods were used for statistical analysis,and normally distributed measurement data were expressed as Mean±SD.Results A total of 11 patients were included,comprising 7 males and 4 females,aged between 19 and 55 years,with an average age of 31.5 years.Among them,there were 3 cases of dermatofibrosarcoma protuberans,4 cases of invasive fibroma,1 case of mucinous fibrosarcoma,2 cases of malignant fibrous histiocytoma,and 1 case of squamous cell carcinoma of the skin.The tumor lesion ranged from 5.5 cm×8.0 cm to 9.0 cm×19.0 cm,and the tumor resection range during surgery was from 6.5 cm×9.0 cm to 10.0 cm×20.0 cm.The size of the skin flap ranged from 7.5 cm×11.0 cm to 10.0 cm×22.5 cm.The average thickness of the flap before thinning was 2.2 cm(1.6-3.5 cm),and the average thickness after thinning was 1.2 cm(0.9-1.7 cm).One case of superficial necrosis occurred at the edge of the flap measuring 1.5 cm×2.0 cm after surgery,and the wound healed after dressing changes.One case of arterial crisis occurred 48 hours after surgery,

关 键 词：修复外科手术 肢体肿瘤 股前外侧皮瓣 肿瘤整形外科 

分 类 号：R738.1[医药卫生—肿瘤]