游离股前外侧改良桥式血管蒂皮瓣修复小腿复杂软组织缺损  

Free anterolateral thigh modified bridge vascular pedicle flap repaired complex soft tissue defect of lower limb

作　　者：邢新风 周树萍 郑立武 王焕鹏 常超楠 陈俊杰 黄原宁 李士民[1] XING Xinfeng;ZHOU Shuping;ZHENG Liwu(Department of Burn and Plastic Surgery,The 988 Hospital of Joint Logistic Support Force,Zhengzhou,Henan,450000,China)

机构地区：[1]中国人民解放军联勤保障部队第988医院烧伤整形外科,河南郑州450000 [2]中国人民解放军联勤保障部队第920医院骨科,云南昆明650000

出　　处：《实用手外科杂志》2025年第1期58-61,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨游离股前外侧改良桥式血管蒂皮瓣移植修复小腿复杂软组织缺损患者的临床疗效。方法2018年7月-2023年7月应用游离股前外侧改良桥式血管蒂皮瓣联合VSD负压引流术修复小腿复杂软组织缺损创面9例,均伴主干血管损伤,创面污染严重。一期清创后行VSD覆盖术,待感染控制后实施股前外侧皮瓣游离移植与健侧胫后血管桥接修复创面。术后4~6周行断蒂术,同时对皮瓣进行修整。结果术后皮瓣均成活良好,皮片包裹的血管桥均通畅良好,可见明显的动脉搏动。待皮瓣成活稳定后,二期行断蒂+健侧胫后动脉吻合术,术后均恢复良好。9例均获得随访,皮瓣均成活良好,未见明显渗液,皮瓣的颜色及皮温正常,毛细血管反应可,皮瓣柔软,外形也接近正常,且患肢功能恢复良好,皮瓣供区愈合良好,无明显瘢痕形成,术后患者满意度高。结论游离股前外侧改良桥式血管蒂皮瓣是修复小腿复杂软组织缺损创面一种有效的治疗方法。Objective To investigate the clinical effect of free anterolateral thigh modified bridge vascular pedicle flap transplantation in repairing complex soft tissue defects of lower limbs.Methods From July 2018 to July 2023,a total of 9 patients with complex soft tissue wound defects in the lower limbs were treated with a combination of free anterolateral thigh modified bridge vascular pedicle skin flap and VSD negative pressure drainage surgery.All the patients had wound defects accompanied by main vessel damage and severe wound contamination.VSD coverage was 7-10 days after the first-stage debridement,and VSD surgery could be performed multiple times.After the wound was fresh,free transplantation of anterolateral thigh flap and vascular bridge of healthy posterior tibial vessel were performed to repair the wound.External fixation bracket firmly fixed both lower limbs.The second surgery:pedicle amputation+vascular transplantation+vascular repair was performed 4-6 weeks after the first surgery.Meanwhile,the skin flap was trimmed.Results All the free flaps survived well without necrosis,infection and arteriovenous crisis.The vascular bridges covered by the skin were smooth and obvious arterial pulsation could be seen.After the survival and stability of the skin flap,the second stage of pedicle amputation and bridge vascular replantation were performed,and the patients recovered well.All 9 patients were followed up.The skin flap survived well,no obvious exudation was observed,the skin color and skin temperature of the flap were normal,the capillary reaction was normal,the skin flap was soft,and the appearance was close to normal,and the function of the affected limb was recovered well,the wound of the donor area of the thigh flap healed in stage I without obvious scar formation,and the patient's postoperative satisfaction was also high.Conclusion The free anterolateral thigh modified bridge vascular pedicle skin flap is an effective treatment method for repairing complex soft tissue defects in the lower limbs.

关 键 词：桥式血管蒂皮瓣 小腿 感染创面 显微外科技术 

分 类 号：R65[医药卫生—外科学]