分叶股前外侧穿支皮瓣在四肢软组织缺损修复中的应用  

Application of lobulated anterolateral thigh perforator flap in repair of soft tissue defect of limbs

作　　者：战杰[1] 孙鹏[1] 吴锦生[1] 王思夏[1] 马俊伟[1] 申林[1] 邢长泰 刘岳 Zhan Jie;Sun Peng;Wu Jinsheng;Wang Sixia;Ma Junwei;Shen Lin;Xing Changtai;Liu Yue(Department of Hand Surgery,the Affiliated Central Hospital of Shenyang Medical College,Shenyang 110024,China)

机构地区：[1]沈阳医学院附属中心医院手外四科,沈阳110024

出　　处：《中国临床解剖学杂志》2024年第5期564-569,共6页Chinese Journal of Clinical Anatomy

摘　　要：目的报道应用分叶股前外侧穿支皮瓣修复四肢大面积软组织缺损的临床效果。方法2014年11月至2024年4月,应用分叶股前外侧穿支皮瓣修复四肢复杂软组织缺损168例。皮瓣切取面积24 cm×7 cm~37 cm×10 cm。穿支皮瓣的动脉、静脉、皮神经分别与受区动脉、静脉、皮神经吻合,168例供区均一期直接缝合。术后随访5个月~7年,随访方式门诊及微信,内容包括皮瓣血运、色泽及质地、外观、感觉恢复及供区愈合情况。结果165例皮瓣全部成活,无感染发生。1例单叶皮瓣坏死,2例皮瓣完全坏死,二次手术清创,待创面清洁后予以游离皮片移植,创面愈合。皮瓣供区一期美容缝合,无骨筋膜室综合征发生。术后随访5个月~7年,成活皮瓣血运良好,色泽、质地与受区相近,其中3例外形略臃肿,二期行皮瓣整形手术,术后外形满意。皮瓣供区术后呈线形瘢痕,位置隐蔽,无明显增生。结论股前外侧穿支皮瓣由旋股外侧动脉滋养,该动脉解剖分支位置相对稳定,穿支多,适合进行分叶皮瓣的设计。分叶设计及切取的方式既可以修复位置相近的多处创面;又可以将受区的宽度转化为供区的长度,使供区一期闭合创口;同时,在手足解剖分界部位通过分叶设计可以展现良好的生理折线。分叶股前外侧穿支皮瓣是一种理想的的修复四肢复杂软组织缺损的方法。Objective To investigate the clinical effect of repairing large limbs soft tissue defect by using the lobulated anterolateral thigh perforator flap.Methods F168 cases of the lobulated anterolateral thigh perforator flap was used to repair large soft tissue defect of limbs were collected from November 2014 to April 2024.The area of the flap was 24 cm×7 cm-37 cm×10 cm.The arteriovenous and cutaneous nerves of the perforator flap were anastomosed with those of the recipient area.The patients were followed-up by the way of outpatient service and wechat for 5 months-7 years,including flap survival,color and texture,appearance,sensory recovery,donor site healing.Results 165 cases of flap survived without infection.Necrosis occurred in 1 case of perforator flap and 2 cases of the whole flap.The clean wound through debridement operation was healed with free skin transplantation.There was no osteofascial compartment syndrome after cosmetic suture in the donor area.3 cases of the skin flap appearance was slightly bloated,after the second stage of the skin flap plastic surgery,the appearance was satisfactory.After operation,the donor area of the flap showed linear scar with concealed location and no obvious hyperplasia.Conclusions The anterolateral femoral perforator flap is nourished by the lateral circumflex femoral artery,which has relatively stable anatomic branches and many perforating branches,and is suitable for the design of lobed flap.The lobular design and incision method can repair multiple wounds in similar locations.In addition,the width of the recipient area can be converted into the length of the donor area,so that the donor area can close the wound in the first stage.At the same time,the anatomical boundary of the hands and feet can show a good physiological fold line through the segmentation design.Lobulated anterolateral thigh perforator flap is an ideal method to repair complex soft tissue defects of limbs.

关 键 词：分叶 穿支皮瓣 旋股外侧动脉 软组织缺损 四肢 

分 类 号：R616.2[医药卫生—外科学] R625.9[医药卫生—临床医学]