带蒂股前外侧肌皮瓣逆行修复膝关节周围及小腿近端大面积皮肤缺损  

Pedicled anterolateral thigh myocutaneous flap for repair of large skin defects surrounding the knee joint and proximal calf

作　　者：李忠文 徐帅令 吴信举 朱自强 Li Zhongwen;Xu Shuailing;Wu Xinju;Zhu Ziqiang(Department of Hand and Foot Surgery,the Second Affiliated Hospital,Xuzhou Medical University,Xuzhou,Jiangsu Province 221000,China)

机构地区：[1]徐州医科大学第二附属医院手足外科,江苏徐州221000

出　　处：《创伤外科杂志》2025年第2期127-131,共5页Journal of Traumatic Surgery

摘　　要：目的讨论带蒂股前外侧肌皮瓣逆行修复膝关节周围及小腿近端大面积皮肤缺损的临床疗效。方法回顾性分析2018年1月—2022年12月徐州医科大学第二附属医院手足外科收治的膝关节周围及小腿近端皮肤缺损采用带蒂股前外侧肌皮瓣修复患者8例,男性6例,女性2例;年龄30~58岁,平均50.1岁;道路交通伤6例,其他2例。软组织缺损面积最小为110 mm×60 mm,最大为340 mm×140 mm。皮瓣面积最小为130 mm×70 mm,最大为360 mm×160 mm。皮瓣供区直接缝合或皮片移植也可行腹股沟皮瓣及其他局部转移皮瓣修复,术后观察患者伤口愈合、皮瓣成活情况,定期复查随访皮瓣外观、质地、色泽、膝关节功能情况等。结果术后肌皮瓣均成活,其中2例皮瓣远端20 mm×30 mm面积部分坏死,换药后创面顺利愈合。患者均获得3~12个月随访,平均8.2个月。经过股外侧肌与皮瓣的平铺均增加创面覆盖面积约30%左右;并在覆盖创面的同时利用部分阔筋膜早期重建膝关节韧带,膝关节功能均恢复良好,膝关节活动度屈伸范围20°~100°,内旋及外旋范围10°~20°。皮瓣外观稍显臃肿,色泽与受区相似、质地柔软,供区无活动障碍。结论采用肌肉蒂股前外侧肌皮瓣逆行覆盖膝关节周围及小腿近端大面积皮肤缺损具有最大程度增加有效修复面积、促进膝关节功能早期恢复的特点,临床效果满意,值得推广。Objective To explore the clinical effect of pedicled anterolateral thigh myocutaneous flap in retrograde repair of large skin defects surrounding the knee joint and proximal calf.Methods From Jan.2018 to Dec.2022,8 such patients(6 males and 2 females,aged 30-58 years,with an average of 50.1 years)who were treated in our department were retrospectively analyzed.There were 6 road traffic accidents and 2 others.The skin defect was minimally 110 mm×60 mm and maximally 340 mm×140 mm,with the flap being 130 mm×70 mm and 360 mm×160 mm.The donor site was directly sutured or repaired by skin transplantation or with inguinal flap or other local flaps.After surgery,the wound healing and survival of the flap were observed,and regular follow-up was conducted to assess the appearance,texture,and color of the flap,as well as knee functions.Results All the myocutaneous flaps survived.Among them,2 cases had partial necrosis in the distal end(20 mm×30 mm),which healed smoothly after dressing change.Patients were followed up for 3-12 months,with an average of 8.2 months.The coverage area of the wound was increased by about 30%after tiling the lateral femoral muscle and skin flap.At the same time,the partial fascia lata was used to reconstruct the knee ligament at an early stage.For all the patients,the knee joint function recovered well:flexion and extension range of mobility being 20°-100°,and internal and external rotation being 10°-20°.At the last follow-up,the flap was slightly bloated with a similar color to the recipient and soft texture;for the donor site,there was no movement dysfunction.Conclusion Retrograde coverage of large skin defects around the knee joint and the proximal calf by using pedicled anterolateral thigh myocutaneous flap has the characteristics of maximizing the effective repair area and promoting the early recovery of knee joint function.The clinical effect is satisfactory and worth popularization.

关 键 词：皮肤缺损 下肢创面 带蒂股前外侧肌皮瓣 修复 

分 类 号：R658[医药卫生—外科学]