双侧股前外侧皮瓣修复全足皮肤脱套伤创面的血供重建方式及疗效分析  

Classification and effective analysis of various blood supply reconstruction methods for using the bilateral anterolateral thigh flaps to repair the wound of whole foot degloving injury

作　　者：周荣 巨积辉 刘禹城 杨亮 郭礼平 柳志锦 王桂洋 杨林 程俊楠 黄永涛 葛成伟 金乾衡 曹阳 王石 董帅 Rong Zhou;Jihui Ju;Yucheng Liu;Liang Yang;Liping Guo;Zhijin Liu;Guiyang Wang;Lin Yang;Junnan Cheng;Yongtao Huang;Chengwei Ge;Qianheng Jin;Yang Cao;Shi Wang;Shuai Dong(Department of Wound Repair,Suzhou Ruihua Orthopedic Hospital,Suzhou 215104,China;Department of Hand Surgery,Suzhou Ruihua Orthopedic Hospital,Suzhou 215104,China;Department of Foot and Ankle Surgery,Suzhou Ruihua Orthopedic Hospital,Suzhou 215104,China)

机构地区：[1]苏州瑞华骨科医院创面修复科,215104 [2]苏州瑞华骨科医院手外科,215104 [3]苏州瑞华骨科医院足踝外科,215104

出　　处：《中华损伤与修复杂志（电子版）》2024年第4期299-306,共8页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：苏州市重点学科(SZXK202127);苏州市科技计划项目(SKYD2023026);苏州市吴中区科技计划项目(WZYW2022035)。

摘　　要：目的:探讨双侧股前外侧皮瓣组合修复全足皮肤脱套伤创面的血供重建方式及临床疗效。方法:回顾性分析2020年3月至2022年12月苏州瑞华骨科医院创面修复科应用双侧股前外侧皮瓣串联组合修复全足脱套伤创面患者18例(36块皮瓣)资料,单块皮瓣面积24 cm×7 cm~42 cm×11 cm,采用直接串联、内增压后串联或串联后混合内增压3种不同血供重建方式组合2块皮瓣。术后观察记录皮瓣张力、皮色、皮温、毛细血管反应、皮瓣存活情况、伤口愈合时间,如有血管危象等异常表现需及时处理。随访时观察皮瓣外形及功能恢复情况,供瓣区瘢痕及功能影响等。术后末次随访时,采用综合评价量表评定皮瓣修复效果,采用英国医学研究会(BMRC)感觉功能评定标准评定皮瓣感觉功能。结果:18例(36块皮瓣)皮瓣均成功切取。8例(16块皮瓣)皮瓣内穿支均共干,双侧股前外侧皮瓣直接行串联修复足部创面;6例(12块皮瓣)皮瓣内部分穿支不共干,进行内增压后串联修复足部创面;4例(8块皮瓣)皮瓣部分穿支不共干,行串联混合内增压后修复足部创面。术后3例(3块皮瓣)出现张力高、皮色暗、皮温凉、毛细血管反应快等静脉危象表现,通过手术探查后危象解除。供受区伤口2~3周愈合,皮瓣全部存活。术后随访11.3(10~27)个月。11例皮瓣外形臃肿,影响穿鞋,于皮瓣修复术后6~9个月行Ⅱ期皮瓣修薄整形术。末次随访,大腿供区遗留线状瘢痕,膝关节、髋关节运动功能无明显不良影响;18例(36块皮瓣)皮瓣修复效果评定为优者13例(26块皮瓣)、良者5例(10块皮瓣),皮瓣感觉功能评定为S2~S3级。结论:双侧股前外侧皮瓣串联组合,穿支增压方式灵活,血供可靠,覆盖创面面积大,供区损伤小,可获得较为满意的皮瓣修复效果及感觉功能,是修复足脱套伤创面的理想方法之一。Objective To explore the anastomotic method and clinical efficacy of the combined bilateral anterolateral thigh flap for repairing the degloving injury of the whole foot.Methods A retrospective study spanning from March 2020 to December 2022 involving 18 patients whose foot degloving injury were treated in the Department of Wound Repair in Suzhou Ruihua Orthopedic Hospital by a combination of bilateral anterolateral thigh flap(36 flaps)has been completed.The single harvested flap area ranged from 24 cm×7 cm to 42 cm×11 cm.Bilateral flaps were combined using three methods,including series connection,series connection after single zone turbocharge and dual zone turbocharge after series connection.The tension,color,temperature,capillary reaction,survival rate of flaps,and wound healing time were observed and recorded.If there were any abnormal manifestations such as vascular crisis,timely treatment should be taken.During follow-up,the appearance and functional recovery of the flap,as well as the scar and functional impact on the donor site,had been given special attention.At the last follow-up,the comprehensive evaluation scale was used to evaluate the effectiveness of flap,and the British medical research council(BMRC)sensory function evaluation standard was used to evaluate the sensory function of skin flap.Results All flaps were successfully harvested.16 flaps of 8 cases had common perforating branches were directly connected in series,12 flaps of 6 cases whose perforaters derive from different source underwent turbocharging followed by series connection.8 flaps of 4 cases were treated with dual zone turbocharge after series connection because of the different pedicles.3 flaps of three cases suffered a vein risk,and the risk was relieved through a surgery.All the flaps survived and the wounds in the donor and recipient areas healed by first stage within 2~3 weeks.All the cases were followed-up for an average period of 11.3(10~27)months.11 flaps in eleven cases were too blated to be placed inside shoes and were

关 键 词：脱套伤 穿支皮瓣 显微外科手术 足损伤 

分 类 号：R622[医药卫生—整形外科]