股前外侧单穿支分叶皮瓣联合动脉端侧吻合法修复四肢大面积软组织缺损  

Application of end-to-side arterial anastomosis in the transplantation of lobulated free anterolateral thigh flap with a single perforating branch for repair of large soft tissue defects in limbs

作　　者：邱海胜[1] 倪晓[2] 余方正 Qiu Haisheng;Ni Xiao;Yu Fangzheng(Department of Hand Surgery and Peripheral Neurosurgery,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China;Department of National Clinical Key Specialty(Wound Repair Department),the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院手外科、周围神经外科,温州325000 [2]温州医科大学附属第一医院国家临床重点专科(创面修复科),温州325000

出　　处：《中华整形外科杂志》2024年第9期970-976,共7页Chinese Journal of Plastic Surgery

摘　　要：目的探讨游离股前外侧单穿支分叶皮瓣联合动脉端侧吻合法修复四肢大面积软组织缺损的临床效果。方法回顾性分析2014年1月至2022年9月, 在温州医科大学附属第一医院应用游离股前外侧单穿支分叶皮瓣联合动脉端侧吻合法修复的四肢大面积软组织缺损患者的临床资料。术前以多普勒超声确定旋股外侧动脉降支及1条穿支穿出点, 根据创面形状及大小, 沿髂前上棘至髌骨外上缘的连线纵行设计并切取股前外侧单穿支分支的分叶皮瓣, 将皮瓣移植到四肢受区, 合理组合后覆盖创面, 在受区动脉侧方剪出相应大小的卵圆形孔, 将皮瓣中旋股外侧动脉降支与之行端侧吻合, 而两者的伴行静脉仍行端端吻合;供区切口直接拉拢缝合。术后对皮瓣成活情况、皮瓣外形、色泽、质地, 以及供区切口愈合、瘢痕情况、肢体功能进行随访和观察。结果共纳入18例患者, 其中男12例, 女6例;年龄41~60岁, 平均48.5岁;手部及腕部8例, 前臂4例, 小腿4例, 足部2例;创面大而不规则, 或有多个缺损创面, 均伴有肌腱或骨外露, 创面面积为5 cm×13 cm~17 cm×28 cm。术中切取分叶皮瓣面积为3 cm×9 cm~24 cm×10 cm, 组合后的皮瓣面积为6 cm×14 cm~18 cm×30 cm。术后有1例患者皮瓣出现动脉危象, 经探查重新吻合动脉后成活;其余皮瓣均顺利成活。术后随访3个月至4年, 皮瓣无明显回缩, 皮瓣外形不臃肿, 色泽及质地与受区周围组织相近, 患者均对外形表示满意;皮瓣供区切口均一期愈合, 仅留有线性瘢痕, 肢体功能无影响。结论应用游离股前外侧单穿支分叶皮瓣可以较好地修复四肢大面积软组织缺损、不规则创面或多个创面, 且供区能直接缝合, 减少了供区的损伤;而供、受区动脉行端侧吻合, 可减少受区主干血管的损伤, 降低血管吻合难度, 皮瓣成活率高。Objective To explore the clinical efficacy of end-to-side arterial anastomosis in the transplantation of the lobulated free anterolateral thigh flap with a single perforating branch to repair large soft tissue defects in limbs.Methods A retrospective analysis was conducted on the clinical data of patients with large soft tissue defects in the limbs who underwent repair using a combination of the lobulated free anterolateral thigh flap with a single perforating branch and end-to-side arterial anastomosis method at the First Affiliated Hospital of Wenzhou Medical University from January 2014 to September 2022.Before surgery,Doppler ultrasound was used to determine the descending branch of the lateral circumflex femoral artery and the perforating point of one perforating branch.Based on the shape and size of the wound,a longitudinal design was made along the line connecting the anterior superior iliac spine to the outer upper edge of the patella,and a lobulated skin flap with a single perforating branch of the lateral circumflex femoral artery was cut and then branched.The skin flap was transplanted to the recipient site of the limbs,and after reasonable combination,the wound was covered.An oval hole of suitable size was cut on the side of the receiving artery.The descending branch of the lateral circumflex femoral artery in the skin flap was anastomosed end-to-side with it,while the accompanying veins of the two were still anastomosed end-to-end.The incision was directly sutured in the donor area.Follow up and observation were conducted for the survival status,appearance,color,texture,wound healing,scar condition,and limb function of the skin flap after surgery.Results A total of 18 patients were included,including 12 males and 6 females,age range:41-60 years old,with an average of 48.5 years old.There were 8 cases of hands and wrists,4 cases of forearms,4 cases of calves,and 2 cases of feet.The wound was large and irregular,or with multiple defects,all accompanied by bone or tendon exposure,with a wound area of 5

关 键 词：外科皮瓣 股前外侧皮瓣 穿支皮瓣 分叶皮瓣 血管吻合 显微外科技术 四肢 创面 

分 类 号：R658[医药卫生—外科学]