浅筋膜层浅、深脂肪交界平面切取超薄游离股前外侧皮瓣修复足部软组织缺损  

Super-thin free anterolateral thigh flap harvested at the junction plane of superficial and deep fat of superficial fascia to repair soft tissue defect of foot

作　　者：郭涛 刘宏君 张翘楚 王洋 金鹏 张文忠 许涛 袁超群 顾加祥 Guo Tao;Liu Hongjun;Zhang Qiaochu;Wang Yang;Jin Peng;Zhang Wenzhong;Xu Tao;Yuan Chaoqun;Gu Jiaxiang(Department of Hand and Foot Surgery,Northern Jiangsu People's Hospital Affiliated to Yangzhou University,Yangzhou 225001,China;Yangzhou University,Yangzhou 225001,China;Dalian Medical University,Dalian 116000,China;Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]扬州大学附属苏北人民医院手足外科,扬州225001 [2]扬州大学,扬州225001 [3]大连医科大学,大连116000 [4]徐州医科大学,徐州221000

出　　处：《中华整形外科杂志》2024年第9期954-962,共9页Chinese Journal of Plastic Surgery

摘　　要：目的探讨在浅筋膜层浅、深脂肪交界平面获取超薄游离股前外侧皮瓣修复足部软组织缺损的临床效果。方法回顾性分析2017年6月至2022年12月扬州大学附属苏北人民医院收治的足部软组织缺损患者临床资料。术中均在浅筋膜层浅、深脂肪交界平面切取患侧超薄游离股前外侧皮瓣修复足部创面, 供区创面直接拉拢缝合或移植全厚皮片修复。术后观察皮瓣成活及并发症发生情况, 并从以下5个方面对手术效果进行评估:(1)采用Maryland足功能评分标准评估足部功能恢复情况, 满分100分, 其中90~100分为优, 75~89分为良, 50~74分为可, <50分为差。(2)采用温哥华瘢痕量表(VSS)对足部瘢痕情况进行评估, 总分为0~15分, 得分越高瘢痕越严重。(3)采用寒冷不耐受症状严重程度(CISS)量表评估患足耐受寒冷情况, 总分为4~100分, 得分越高症状越严重。(4)测量静态两点辨距觉评估足部感觉, 测定值越小感觉恢复越好。(5)调查患者对足部外观的满意度, 分为非常满意、满意、一般、不满意、非常不满意5个等级。采用SPSS 26.0软件对数据进行描述性分析。结果共纳入13例足部软组织缺损患者, 其中男8例, 女5例;年龄39 ~70岁, 平均54.7岁;左足10例, 右足3例;彻底清创后创面面积为5.5 cm ×5.0 cm ~ 22.0 cm ×18.0 cm;手术时间为(145.1 ± 30.6) min;切取皮瓣面积为6.0 cm×5.5 cm ~ 23.5 cm×19.0 cm, 厚度为(5.2 ± 1.1) mm(3.0 ~ 6.5 mm)。9例供区直接缝合, 4例移植腹部全厚皮片修复。术后有1例患者皮瓣远端部分表皮坏死, 1例出现静脉危象, 对症处理后皮瓣均成活;其余11例皮瓣均顺利成活。术后随访12~20个月, 平均16个月, 足部皮瓣质地柔软、无破损, 均不需行二次减脂或塑形手术。供区除4例移植皮片的患者因瘢痕增生致感觉减退外, 其余均无创口裂开、皮片坏死、肌疝、股四头肌肌无力等并发症发生。末次随访时, Maryland�Objective To investigate the clinical effect of super-thin free anterolateral thigh(ALT)flap at the junction plane of superficial and deep fat of superficial fascia to repair the soft tissue defects of the foot.Methods The clinical data of patients with foot soft tissue defects admitted to Northern Jiangsu People’s Hospital Affiliated to Yangzhou University from June 2017 to December 2022 were retrospectively analyzed.During the operation,the super-thin free ALT flap on the affected side was harvested at the junction of superficial and deep fat of superficial fascia to repair the foot wound.The donor site wound was sutured directly or repaired with full-thickness skin graft.The flap survival and complications were observed after the operation,and the operation effect was evaluated from the following five aspects.(1)The Maryland foot function score was used to evaluate the recovery of foot function.The full score was 100 points,of which 90-100 points were excellent,75-89 points were good,50-74 points were fair,and<50 points were poor.(2)The Vancouver scar scale(VSS)was used to evaluate the scar condition of the foot.The total score was 0-15 points.The higher the score,the more serious the scar.(3)The cold intolerance symptom severity(CISS)scale was used to evaluate the cold tolerance of the affected foot.The total score was 4-100 points.The higher the score,the more serious the symptoms.(4)Measuring static two-point discrimination to evaluate foot sensation,the smaller the measured value,the better the sensory recovery.(5)The satisfaction of patients with foot appearance was investigated,which was divided into five grades:very satisfied,satisfied,general,dissatisfied and very dissatisfied.Descriptive analysis of the data was performed using SPSS 26.0 software.Results A total of 13 patients with foot soft tissue defects were enrolled,including 8 males and 5 females.The mean age was 54.7 years(range,39-70 years).There were 10 cases of left foot and 3 cases of right foot.The wound area after thorough debridement ra

关 键 词：外科皮瓣 超薄皮瓣 股前外侧皮瓣 穿支皮瓣 足 软组织缺损 

分 类 号：R658.3[医药卫生—外科学]