红外热成像仪辅助穿支定位的旋股外侧嵌合皮瓣在四肢关节复合组织缺损中的立体修复策略  

Three-dimensional reconstruction strategy for infrared thermography-assisted perforator localization of pedicled anterolateral thigh flap in limb joint composite tissue defects

作　　者：李海 邓呈亮 肖顺娥 吴祥奎 吴必华 魏在荣 Li Hai;Deng Chengliang;Xiao Shune;Wu Xiangkui;Wu Bihua;Wei Zairong(Department of Burns and Plastic Surgery,Affiliated Hospital of Zunyi Medical University,The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University,Zunyi 563000,China)

机构地区：[1]遵义医科大学附属医院烧伤整形外科,遵义医科大学组织损伤修复与再生医学省部共建协同创新中心,遵义563000

出　　处：《中华手外科杂志》2024年第4期325-329,共5页Chinese Journal of Hand Surgery

摘　　要：目的探讨红外热成像技术辅助旋股外侧动脉穿支嵌合筋膜皮瓣在关节复合组织缺损重建中的立体修复方法及临床效果.方法自2019年1月至2023年12月我们对16例四肢关节复合组织缺损患者,采用红外热成像仪辅助游离旋股外侧动脉穿支嵌合筋膜皮瓣进行立体重建,其中5例合并少量关节部位骨质部分缺损,1例合并肌腱缺损.创面面积24 cm×11 cm~6 cm×3 cm,皮瓣大小20 cm×6 cm~6 cm×3 cm,筋膜瓣面积6.0 cm×4.0 cm~3.0 cm×1.5 cm.供区阔筋膜及皮瓣一期缝合.结果术前共探查穿支48条,术中证实穿支45条,阳性率93.4%.术后16例患者均获得随访,时间为1~35个月,平均9.4个月.16例皮瓣全部存活,皮瓣质地柔软,外形满意,随访期内关节无窦道、肿胀、疼痛表现,关节活动无明显障碍,2例患者自觉皮瓣部位臃肿,二期行皮瓣修薄术.结论红外热成像技术辅助穿支定位旋股外侧动脉穿支嵌合筋膜皮瓣立体修复关节部位复合组织缺损安全可靠,是关节复合组织缺损重建的理想方法之一.Objective To explore the three-dimensional reconstruction method and clinical outcomes of using infrared thermography-assisted pedicled anterolateral thigh myocutaneous flap with perforator for joint composite tissue defect repair.Methods A retrospective analysis was conducted on clinical data from January 2019 to December 2023,involving 16 patients with joint composite tissue defects treated at our hospital.Infrared thermography was used to assist in the precise positioning of the perforators for the pedicled anterolateral thigh myocutaneous flap.Among them,5 cases were accompanied by a small amount of bone defects in the joint area,and 1 case was accompanied by tendon defects.The wound area was 24 cm×11 cm to 6 cm×3 cm,the flap size was 20 cm×6 cm to 6 cm×3 cm,and the fascia flap area was 6.0 cm×4.0 cm to 3.0 cm×1.5 cm.The fascia lata and skin flap in the donor area were sutured directly.Results A total of 48 perforators were explored preoperatively,with 45 being confirmed intraoperatively,yielding a positive rate of 93.4%.All 16 patients were follow-up for a period ranging from 1 to 35 months,with an average of 9.4 months.All flaps survived without complications,exhibiting soft texture and satisfactory appearance.During the follow-up period,there were no signs of sinus formation,swelling,or pain in the joint area,and joint mobility was not significantly impaired.Two patients reported localized flap swelling during follow-up,and secondary thinning procedures were performed in these cases.Conclusion Infrared thermography-assisted perforator localization for pedicled anterolateral thigh myocutaneous flap is a safe and reliable three-dimensional reconstruction method for joint composite tissue defects.It represents an ideal approach for the reconstruction of joint composite tissue defects.

关 键 词：外科皮瓣 显微外科手术 红外热成像技术 软组织损伤 

分 类 号：R726.5[医药卫生—儿科]