股前外侧穿支皮瓣的个性化精准设计:十年1079例临床疗效分析  

Individualized precision design of anterolateral thigh perforator flaps:a clinical effectiveness analysis of 1079 cases over ten years

作　　者：唐举玉[1,2] 孙念哲 吴攀峰[1,2] 俞芳 曾磊[1,2] 卿黎明 肖勇兵[1,2] 潘丁 刘睿[1,2] 符劲飞 贺继强[1,2] 李诚 Tang Juyu;Sun Nianzhe;Wu Panfeng;Yu Fang;Zeng Lei;Qing Liming;Xiao Yongbing;PanDing;Liu Rui;Fu Jinfei;He Jiqiang;Li Cheng(Department of Orthopaedics,Hand and Microsurgery,Xiangya Hospital,Central South University,Changsha 410008,China;National Clinical Research Center for Geriatric Diseases,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院骨科-手显微外科,长沙410008 [2]国家老年疾病临床医学中心(湘雅医院),长沙410008

出　　处：《中国临床解剖学杂志》2024年第5期510-516,共7页Chinese Journal of Clinical Anatomy

基　　金：国家自然科学基金(81871577);骨科-国家临床重点专科建设经费(z047-01)。

摘　　要：目的探讨个性化精准设计的股前外侧穿支皮瓣重建各种复杂组织缺损的临床疗效。方法回顾分析我科2013年1月-2023年1月采用个性化精准设计的各种股前外侧穿支皮瓣修复的1079例患者的临床疗效。以旋股外侧动脉降支为血管蒂切取1013例(其中小儿65例)、横支为血管蒂切取40例、斜支为血管蒂切取26例(小儿1例),以旋股内侧动脉或股动脉来源穿支为蒂切取9例。其中传统股前外侧穿支皮瓣游离移植441例、带蒂转移27例、特殊形式穿支皮瓣基本术式511例、衍生术式100例。修复下肢787例,上肢264例,躯干部17例,头颈部4例,上述多部位7例。并对各种个性化精准设计的股前外侧穿支皮瓣术后临床疗效及并发症发生率进行统计比较。结果本组1079例股前外侧穿支皮瓣中,术后顺利成活1063例,其中发生血管危象行探查术成活14例,总成功率为98.52%。比较游离股前外侧穿支皮瓣、带蒂转移、特殊形式穿支皮瓣基本术式和衍生术式各组成功率,结果显示各组间成功率无明显差异(P>0.05)。本组1079例股前外侧穿支皮瓣主要并发症发生情况:静脉危象35例(3.24%),动脉危象22例(2.04%),感染19例(1.76%),切口延迟愈合6例(0.56%),完全坏死16例(1.48%),部分坏死35例(3.24%)。统计学分析显示静脉危象方面特殊形式穿支皮瓣基本类型组发生率低于衍生术式组(P<0.001),切口感染方面带蒂转移组发生率高于特殊形式穿支皮瓣组(P=0.007),切口延迟愈合方面传统游离移植组发生率高于特殊形式穿支皮瓣组(P=0.04),皮瓣部分坏死方面带蒂转移组发生率高于特殊形式穿支皮瓣组(P=0.008)。结论股前外侧穿支皮瓣个性化精准设计,可以获得良好的临床疗效,值得临床推广应用。Objectives To investigate the clinical efficacy of individualized precision design using anterolateral thigh perforator flaps for reconstructing various complex tissue defects.Methods A retrospective analysis was conducted on 1079 patients who underwent reconstruction using individualized precision-designed anterolateral thigh perforator flaps at our department from January 2013 to January 2023.The descending branches of the lateral circumflex femoral artery were utilized as the vascular pedicle(including 65 pediatric cases)in 1013 cases,transverse branches in 40 cases,oblique branches(including 1 pediatric case)in 26 cases,and descending branch of the medial circumflex femoral artery or femoral artery perforators as the pedicle in 9 cases.Procedures included 441 cases of free flap transplantation,27 cases of pedicle transfer,511 cases of basic types of special form perforator flaps,and 100 cases of derivatives.Defects repaired included 787 cases in the lower limbs,264 cases in upper limbs,17 cases in trunk,4 cases in headneck region and 7 cases in multiple sites.Postoperative clinical outcomes and complication rates of various individualized precision designs of anterolateral thigh perforator flaps were statistically analyzed and compared.Results Among the 1079 cases of anterolateral thigh perforator flaps,1063 cases survived postoperatively,with 14 cases undergoing vascular exploration due to vascular crisis,yielding an overall success rate of 98.52%.Comparison of success rates among free anterolateral thigh perforator flaps,pedicled flaps,basic types and derivatives of special form perforator flaps revealed no significant differences in success rates(P>0.05).Complications included venous crisis in 35 cases(3.24%),arterial crisis in 22 cases(2.04%),infection in 19 cases(1.76%),delayed wound healing in 6 cases(0.56%),complete necrosis in 16 cases(1.48%),and partial necrosis in 35 cases(3.24%).In terms of venous crisis,the incidence rate of perforator flaps in basic types group was lower than that in derivatives

关 键 词：股前外侧 穿支皮瓣 个性化 精准重建 皮肤软组织缺损 

分 类 号：R622[医药卫生—整形外科]