游离股外侧肌肌瓣联合皮片移植修复糖尿病足非负重区中小面积腔隙性缺损创面  

Free vastus lateralis flap combined with skin grafting for repairing small-and mediumsized lacunar defects in non-weight-bearing area of diabetic foot

作　　者：常树森 税兰 简扬 陈伟 周健 聂开瑜 魏在荣 CHANG Shusen;SHUI Lan;JIAN Yang;CHEN Wei;ZHOU Jian;NIE Kaiyu;WEI Zairong(Department of Burns and Plastic Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou,563003,P.R.China;The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University,Zunyi Guizhou,563003,P.R.China;Early Clinical Research Ward,Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou,563003,P.R.China)

机构地区：[1]遵义医科大学附属医院烧伤整形外科,贵州遵义563003 [2]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,贵州遵义563003 [3]遵义医科大学附属医院早期临床研究病房,贵州遵义563003

出　　处：《中国修复重建外科杂志》2024年第9期1111-1116,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：省部共建协同创新中心项目[教科技厅函(2020)39号];贵州省科技计划项目[黔科合成果-LC(2024)084号];创面精准修复创新人才平台载体建设项目[遵市科人平台(2021)3号]。

摘　　要：目的探讨游离股外侧肌肌瓣联合皮片移植修复糖尿病足非负重区中小面积腔隙性缺损创面的可行性和疗效。方法2022年1月—2023年10月,收治8例(8足)糖尿病足非负重区中小面积腔隙性缺损创面患者。男6例,女2例;年龄58~76岁,平均64.3岁。糖尿病足溃疡病程2~7周,平均4.3周。创面部位:跖骨间4例,足内侧2例,足外侧1例,足背及足外侧1例。创面范围:长4.0~12.0 cm、宽3.0~5.0 cm、深度1.2~2.0 cm。设计并切取游离股外侧肌肌瓣填塞创面,皮片移植覆盖肌瓣;肌瓣切取范围:长5.0~14.0 cm、宽3.5~6.0 cm、厚度1.0~1.5 cm。肌瓣供区均一期拉拢缝合。结果术中肌瓣切取时间30~80 min,平均55.0 min;总手术时间125~170 min,平均147.5 min。术后肌瓣及皮片均顺利成活,创面及供区切口均Ⅰ期愈合。8例患者均获随访,随访时间6~24个月,平均12.8个月。3例术后未遵医嘱进行肌瓣压力治疗者外观稍臃肿,其余患足外观均良好;修复部位质地柔软。肌瓣供区残留线状瘢痕。随访期间足部溃疡无复发,末次随访时患者均可独立行走,日常活动不受限。结论应用游离股外侧肌肌瓣联合皮片移植修复糖尿病足非负重区中小面积腔隙性缺损创面,具有手术操作简便、省时以及供区损伤小的优势,修复效果好,尤其适用于不耐受长时间麻醉的老年患者。Objective To explore the feasibility and effectiveness of free vastus lateralis flap combined with skin grafting for repairing small-and medium-sized lacunar defects in the non-weight-bearing area of diabetic foot.Methods Between January 2022 and October 2023,8 patients(8 feet)with small-and medium-sized lacunar defects in the non-weight-bearing area of diabetic foot were admitted.There were 6 males and 2 females,with an average age of 64.3 years(range,58-76 years).The duration of the diabetic foot ulcer ranged from 2 to 7 weeks(mean,4.3 weeks).The wound was located between the metatarsal bones in 4 cases,on the medial side of the foot in 2 cases,on the lateral side of the foot in 1 case,and on the dorsal and lateral sides of the foot in 1 case.The length of wound was 4.0-12.0 cm,the width was 3.0-5.0 cm,and the depth was 1.2-2.0 cm.The free vastus lateralis flaps were designed to repair the wounds,and skin grafting covered the vastus lateralis flaps.The length of the vastus lateralis flap was 5.0-14.0 cm,the width was 3.5-6.0 cm,and the thickness was 1.0-1.5 cm.The donor sites of the muscle flaps were directly sutured.Results The time for vastus lateralis flaps harvested ranged from 30 to 80 minutes(mean,55.0 minutes),and the total operation time ranged from 125 to 170 minutes(mean,147.5 minutes).All muscle flaps and skin grafts survived successfully,and the wounds and the incisions at the donor sites healed by first intention.All patients were followed up 6-24 months,with an average of 12.8 months.The appearances of 3 patients who did not follow the doctor’s instructions for pressure treatment of the muscle flaps were a little bloated,and the rest had a good appearance.The texture of the muscle flaps was soft.There were linear scars at the donor sites.There was no recurrence of ulcers during follow-up.All patients could walk independently without limitation of daily activities at last follow-up.Conclusion The application of free vastus lateralis flap combined with skin grafting to repair small-and medium-size

关 键 词：糖尿病足溃疡 股外侧肌肌瓣 皮片移植 创面修复 

分 类 号：R587.2[医药卫生—内分泌] R658.3[医药卫生—内科学]