以旋股外侧动脉斜支为蒂并携带阔筋膜的股前外侧穿支皮瓣修复手足毁损性创面并重建功能的效果  

Effects of anterolateral femoral perforator flaps pedicled with oblique branch of lateral circumflex femoral artery and carrying fascia lata in repairing destructive wounds and rebuilding function of hands or feet

作　　者：葛成伟 蒋国栋 程俊楠 郭礼平 车志刚 袁松 巨积辉 Ge Chengwei;Jiang Guodong;Cheng Junnan;Guo Liping;Che Zhigang;Yuan Song;Ju Jihui(Department of Hand Surgery,Suzhou Ruihua Orthopaedic Hospital,Suzhou 215104,China)

机构地区：[1]苏州瑞华骨科医院手外科,苏州215104

出　　处：《中华烧伤与创面修复杂志》2024年第9期842-848,共7页Chinese Journal of Burns And Wounds

基　　金：苏州市重点学科(SZXK202127);苏州市科技发展计划(SKYD2023026)。

摘　　要：目的探讨采用以旋股外侧动脉斜支为蒂并携带阔筋膜的股前外侧穿支皮瓣修复手足毁损性创面并重建功能的效果。方法该研究为回顾性观察性研究。2022年1月—2023年3月,苏州瑞华骨科医院收治16例符合入选标准的合并伸肌腱缺损的手足毁损性创面患者,其中男12例、女4例,年龄3~63岁。创面位于手部者12例、足部者4例。伸肌腱缺损根数为1~5根,缺损长度为2.5~6.0 cm。清创后创面面积为11.0 cm×5.5 cm~29.0 cm×9.5 cm,采用以旋股外侧动脉斜支为蒂并携带阔筋膜的股前外侧穿支皮瓣修复,皮瓣面积为12.0 cm×6.5 cm~30.0 cm×11.0 cm;用阔筋膜修复缺损伸肌腱,阔筋膜切取面积为8.0 cm×3.0 cm~12.0 cm×8.0 cm。将15例患者皮瓣供区创面直接缝合,1例患者皮瓣供区创面采用下腹部中厚皮片覆盖。术后1周内,观察皮瓣成活情况及皮瓣供受区创面愈合情况。术后随访,统计行修薄整形术或肌腱松解术的患者数。末次随访时,评定手部及足部移植皮瓣感觉功能恢复情况,采用皮瓣综合评价量表评定皮瓣修复疗效,依据中华医学会手外科学分会上肢部分功能评定试用标准评定手部功能。比较术前及末次随访时测量的伤指总主动活动度及采用Maryland足部功能评分标准评定的足部功能。结果2例患者术后出现皮瓣动脉危象,经及时探查后皮瓣成活,其余患者术后皮瓣存活良好;供受区术后未见明显瘢痕增生或破溃。所有患者获得随访8~16个月,其中6例患者于术后6~7个月行皮瓣修薄整形术,4例患者于术后3~6个月行肌腱松解术。末次随访时,皮瓣感觉功能恢复达S1级者5例、S2级者11例,两点辨别觉仅有1个点;皮瓣修复疗效评分为80~91分,评定为优者5例、良者9例、可者2例;手部功能评定为优者5例、良者5例、可者2例。所有患者均成功重建伤指/趾主动伸直功能,末次随访时的伤指总主动活动度为(225±22)°,明显高于�Objective To investigate the effects of anterolateral femoral perforator flaps pedicled with oblique branch of lateral circumflex femoral artery and carrying fascia lata in repairing destructive wounds and rebuilding function of hands or feet.Methods This study was a retrospective observational study.From January 2022 to March 2023,16 patients with destructive wounds in hands or feet combined with extensor tendon defects who met the inclusion criteria were admitted to Suzhou Ruihua Orthopedic Hospital,including 12 males and 4 females,aged 3 to 63 years.The wounds were located on the hands in 12 cases and on the feet in 4 cases.The number of defective extensor tendon ranged one to five,and the length of the defect ranged from 2.5 to 6.0 cm.The wound area was 11.0 cm×5.5 cm to 29.0 cm×9.5 cm after debridement.The wounds were repaired with anterolateral femoral perforator flaps pedicled with oblique branch of lateral circumflex femoral artery and carrying fascia lata,and the flap area was 12.0 cm×6.5 cm to 30.0 cm×11.0 cm.The fascia lata was used to repair the extensor tendon defects,and the harvesting area of fascia lata was 8.0 cm×3.0 cm to 12.0 cm×8.0 cm.The wounds in flap donor areas in 15 patients were sutured directly,and the wound in flap donor area in 1 patient was covered with medium-thickness skin graft from lower abdomen.The survival of flaps and the wound healing in donor and recipient areas of flaps were observed within 1 week after operation.The number of patients who underwent thinning and plastic surgery or tenolysis was recorded during postoperative follow-up.At the last follow-up,the recovery of sensory function of the transplanted flaps on hands or feet was evaluated,the efficacy of flap repair was evaluated according to the comprehensive flap evaluation scale,and the function of hands was evaluated according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association.The following two indexes were compared,including

关 键 词：外科皮瓣 阔筋膜 手 足 斜支 股前外侧穿支皮瓣 毁损性创面 创面修复 

分 类 号：R658[医药卫生—外科学]