股前外侧穿支皮瓣切取技巧分析

发布时间：2018-02-01 00:51

本文关键词： 股前外侧穿支皮瓣皮瓣切取技术改良　出处：《中国修复重建外科杂志》2017年01期 　论文类型：期刊论文

【摘要】：目的改进股前外侧穿支皮瓣的切取技巧,减少手术时间。方法选取2008年1月—2015年6月采用股前外侧穿支皮瓣修复的400例患者作为研究对象,分析其皮瓣成功愈合(370例,92.5%)及术后二次探查(30例,7.5%)的技术因素;同时结合文献已报道的皮瓣切取技术,提出一种改良的皮瓣切取技术,即以逆行追踪穿支蒂-顺行切取降支主干的方法切取皮瓣,并于2015年6月—2016年6月应用于100例患者。其中男76例,女24例;年龄11~71岁,平均35.6岁。创面范围8 cm×5 cm~23 cm×9 cm。受伤至手术时间5~31 d,平均14.3 d。结果手术时间为(30.1±19.3)min,较未改进的切取方法手术时间(85.0±30.2)min明显缩短。术后94例皮瓣成活并顺利愈合,创面及切口均Ⅰ期愈合。6例发生血管危象,术后探查发现4例为静脉危象,术后取出血栓,皮瓣完全成活;2例为动静脉危象,探查失败,皮瓣全部坏死后行二期创面植皮+换药后愈合。94例皮瓣成活患者获随访,随访时间3~12个月,平均6.3个月。皮瓣生长良好,其中21例行二期修薄手术。结论改进后的股前外侧穿支皮瓣切取方法可进一步减少手术时间,降低切取难度。
[Abstract]:Objective to improve the technique of excision of anterolateral femoral perforator flap and reduce the operation time. Methods 400 patients with anterolateral femoral perforating branch flap from January 2008 to June 2015 were selected as study objects. The technical factors of 370 cases of successful healing of skin flap and 30 cases of secondary exploration after operation were analyzed. At the same time, combined with the reported flap cutting technique, a modified flap cutting technique was put forward, that is, the flap was obtained by retrograde tracing perforator pedicle and descending branch trunk. It was applied to 100 patients from June 2015 to June 2016, including 76 males and 24 females. The wound area was 8 cm 脳 5 cm~23 cm 脳 9 cm. The injury lasted from 5 days to 31 days. Results the operative time was 30.1 卤19.3 minutes. The operative time was 85.0 卤30.2 minutes shorter than that of the unimproved method. After operation, 94 cases survived and healed smoothly. Vascular crisis occurred in 6 cases of primary wound healing. After operation, 4 cases were found to be venous crisis, thrombus was removed after operation, and the flap survived completely. Two cases were arteriovenous crisis, the exploration failed, the skin flap was completely necrosed and healed after skin grafting. 94 cases were followed up for 3 ~ 12 months. The average number of months was 6.3 months. The flap grew well, of which 21 cases underwent secondary thinning. Conclusion the modified anterolateral femoral perforator flap can further reduce the operation time and difficulty.
【作者单位】：成都军区昆明总医院骨科;西藏军区总医院骨科;罗平县人民医院骨科;
【基金】：成都军区医学科学技术研究计划项目(B14012)~~
【分类号】：R658
【正文快照】： 股前外侧穿支皮瓣已成为目前修复肢体创面的常规方法之一。该皮瓣来源于传统股前外侧皮瓣,由我国徐达传等率先对其进行了解剖学研究[1],宋业光等首先进行了临床报道[2],并主要由中国台湾的魏福全等进行了世界范围内的推广应用[3],成为肢体创面修复领域最受欢迎的皮瓣之一。在

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