分叶股前外侧穿支皮瓣在血管蒂保护中的作用研究

发布时间：2018-04-05 18:39

本文选题：股前外侧穿支皮瓣　切入点：分叶皮瓣　出处：《中国修复重建外科杂志》2017年10期

【摘要】：目的探讨增加蒂部一叶瓣的分叶股前外侧穿支皮瓣修复四肢软组织缺损创面的临床疗效。方法 2014年1月—2017年1月,采用增加蒂部一叶瓣的分叶股前外侧穿支皮瓣修复四肢软组织缺损创面24例。其中男15例,女9例;年龄5~64岁,中位年龄33.5岁。上肢创面8例,合并桡骨茎突骨骨折1例,伸指肌腱外露3例,肱桡肌肌腱外露1例。下肢创面16例,合并跟骨或跖骨、趾骨骨折4例,跟腱离断1例,趾长伸趾肌腱、趾长屈趾肌腱外露8例。创面范围为8 cm×5 cm~18 cm×12 cm。根据创面大小及缺损区域,常规超声多普勒探查旋股外侧动脉穿支(2~5支)并标记;将不规则创面分解成多个部分(分2~4叶)分别计算面积,皮瓣切取范围9 cm×6 cm~20 cm×14 cm,最大单叶瓣切取面积24 cm×6 cm;分叶血管蒂长7~12 cm;蒂部联合创面嵌入分叶瓣面积5 cm×3 cm~7 cm×5 cm。结果术后皮瓣全部成活,无动、静脉危象发生。24例均获随访,随访时间2~28个月,平均9个月。1例合并跟骨骨折行内固定患者皮瓣修复后伴窦道形成,经常规换药后3个月愈合。所有皮瓣均菲薄,无需二次修薄;5例合并骨折者软组织均Ⅰ期愈合。所有患者受区腕关节、踝关节跖屈、背屈功能正常。结论设计增加蒂部一叶瓣的分叶股前外侧穿支皮瓣修复四肢软组织缺损安全可靠,是减少游离股前外侧穿支皮瓣动、静脉危象的方法之一。
[Abstract]:Objective to investigate the clinical effect of repairing soft tissue defect of extremities with the flap of lobulated anterolateral perforating branch of pedicle flap.Methods from January 2014 to January 2017, 24 cases of soft tissue defect of extremities were repaired with lobulated anterolateral femoral perforator flap.Among them, 15 cases were males and 9 cases were females, the age was 564 years old with a median age of 33.5 years.There were 8 cases with upper limb wound, 1 case with fracture of styloid process of radius, 3 cases with tendon exposure of extensor finger and 1 case with tendon of brachioradialis muscle.There were 16 cases with lower extremity wound, 4 cases with calcaneal or metatarsal fracture, 1 case with amputation of Achilles tendon, 8 cases with long extensor digitorum digitorum tendon and 8 cases with long flexor digitorum digitorum tendon exposed.The wound area was 8 cm 脳 5 cm~18 cm 脳 12 cm.According to the wound size and defect area, conventional Doppler ultrasound was used to detect and label 5 perforating branches of lateral circumflex femoral artery, and to decompose the irregular wound into several parts (divided into 2 lobes) to calculate the area.The area of flap was 9 cm 脳 6 cm~20 脳 14 cm, the maximum single lobe flap area was 24 cm 脳 6 cm, the pedicle length was 712 cm, and the flap area was 5 cm 脳 3 cm~7 cm 脳 5 cm.Results all the flaps survived, no artery and venous crisis occurred in all the 24 cases. The follow-up time was 2 ~ 28 months. The average of 9 months was 9 months. The flap was repaired with the internal fixation of calcaneal fracture with sinus formation, and healed 3 months after routine dressing change.All the flaps were thin, and the soft tissues of 5 cases with fracture without secondary repair were all healed in one stage.All patients had normal wrist, ankle metatarsal flexion and dorsiflexion function.Conclusion it is safe and reliable to design a flap with lobulated anterolateral perforating branch of pedicle flap to repair soft tissue defect of extremities. It is one of the methods to reduce the risk of arteriovenous crisis of free anterolateral femoral perforator flap.
【作者单位】：遵义医学院附属医院烧伤整形外科;
【基金】：国家临床重点专科项目[国卫办医函[2013]544号] 贵州省优秀青年科技人才培养对象专项基金[黔科合人字(2013)12号]~~
【分类号】：R658

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