端侧吻合非一级源血管的带感觉股前外侧穿支皮瓣在足踝软组织缺损中的应用  

Sensorial anterolateral thigh flap with end-to-side anastomotic non-primary source vessels for foot and ankle soft tissue defects

作　　者：何建霖 朱必清[1] 张斌斌 王肖肖 钟俊波[1] He Jianlin;Zhu Biqing;Zhang Binbin;Wang Xiaoxiao;Zhong Junbo(Department of Burn and Plastic Surgery,the Fourth People’s Hospital of Zigong,Zigong,Sichuan Province 643000,China)

机构地区：[1]自贡市第四人民医院烧伤整形科,四川自贡643000

出　　处：《创伤外科杂志》2025年第3期205-210,共6页Journal of Traumatic Surgery

基　　金：自贡市重点科技计划(2021YLSF20)。

摘　　要：目的探讨端侧吻合非一级源血管的带感觉股前外侧穿支皮瓣(ALTF)在足踝软组织缺损修复中的应用及对感觉重建、皮瓣血运重建的影响。方法前瞻性研究2019年1月—2023年4月自贡市第四人民医院烧伤整形科收治的104例足踝创面软组织缺损患者,男性55例,女性49例;年龄19~53岁,平均36.1岁。按随机数字表法分为观察组和对照组,各52例。观察组采用端侧吻合非一级源血管的带感觉ALTF修复,对照组采用腹壁下常规动脉穿支皮瓣修复。观察两组组织缺损修复情况,术后1、3个月两点辨别觉距离及触觉,踝后足功能及术后并发症、美观度情况。结果两组皮瓣制备时间、Ⅰ期愈合率、皮瓣成活率比较,差异无统计学意义(P>0.05);观察组创面愈合时间(20.89±5.10)d短于对照组的(24.00±4.85)d(P<0.05);术后1、3个月,观察组两点辨别觉距离分别为(8.32±1.47)mm、(7.06±1.24)mm,均短于对照组的(9.64±1.20)mm、(8.33±1.36)mm,触觉优良率分别为71.2%、96.2%,均高于对照组的51.9%、80.8%(P<0.05);两组术后1、3个月踝后足功能优良率比较,差异无统计学意义(P>0.05);观察组术后并发症发生率3.9%低于对照组17.3%(P<0.05);术后3个月观察组手术位置厚度、顺应度、柔软度评分分别为(2.62±0.31)分、(2.13±0.36)分、(2.64±0.59)分,均低于对照组的(3.58±0.57)分、(2.78±0.42)分、(3.43±0.74)分(P<0.05)。结论端侧吻合非一级源血管的带感觉ALTF修复足踝创面软组织缺损患者效果确切,能促进创面愈合,改善感觉功能,提高美观效果及手术安全性。Objective To explore the application of anterolateral thigh flap(ALTF)with sensory perforator in the repair of soft tissue defects at the foot and ankle,by end-to-side anastomosis of non-primary source vessels,and to observe the sensory reconstruction and flap revascularization.Methods This prospective study was conducted on 104 patients(55 males and 49 females aged 19-53 years,mean 36.1 years)with foot and ankle soft tissue defects and managed in our department from Jan.2019 to Apr.2023.Patients were divided into two groups using a random number table method,with 52 cases in each group.Genranl data and injury severity showed no significant difference between two groups.The intervention group was repaired with a sensory ALTF using end-to-side anastomosis of non-primary source vessels,while the control group was repaired with a conventional subdermal perforator flap of the inferior epigastric artery.The two groups were compared for repair surgery prodecures and outcome parameters of two-point discrimination,tactile sensation,and function by American Orthopaedic Foot&Ankle Society(AOFAS)ankle hindfoot score at 1 and 3 months postoperatively.Postoperative complications and aesthetics were also recorded.Results There was no statistically significant difference in the preparation time of skin flaps,first-stage healing rate,and survival rate of skin flaps between the two groups(all P>0.05).The wound healing time(d)in the observation group was 20.89±5.10,much shorter than that in the control group of 24.00±4.85(P<0.05).At 1 and 3 months after surgery,the two-point discrimination distances(mm)in the observation group were 8.32±1.47 and 7.06±1.24,respectively,shorter than those in the control group(9.64±1.20 and 8.33±1.36,both P<0.05);while the excellent and good rates of tactile sensation were 71.2%and 96.2%,respectively,much higher than those in the control group(51.9%and 80.8%,both P<0.05).The excellent and good rates by AOFAS ankle hindfoot score showed no significant difference between the two groups at 1 and 3

关 键 词：足踝软组织缺损 皮瓣 端侧吻合 两点辨别觉距离 踝后足功能 

分 类 号：R658.3[医药卫生—外科学]