改良股前外侧游离穿支皮瓣桥式交叉移植修复小腿中下段软组织缺损

发布时间：2018-05-09 11:54

本文选题：股前外侧穿支皮瓣 + 软组织缺损　；参考：《中国修复重建外科杂志》2017年10期

【摘要】：目的探讨应用改良股前外侧游离穿支皮瓣桥式交叉移植修复小腿中下段软组织缺损的临床疗效。方法 2011年3月—2015年6月,收治15例小腿中下段皮肤软组织缺损患者。男9例,女6例;年龄22~48岁,平均32.6岁。致伤原因:交通事故伤8例,机器绞伤5例,重物压砸伤2例。受伤至入院时间为2 h~1周,平均86.2 h。创面缺损范围为13 cm×9 cm~23 cm×16 cm。入院后一期清创、负压引流治疗,二期行改良股前外侧游离穿支皮瓣桥式交叉修复创面,皮瓣切取范围15 cm×10 cm~25 cm×15 cm。供区直接缝合或游离植皮修复。修复术后4周断蒂。结果术后1例皮瓣出现血管危象,2例皮瓣部分皮缘发生坏死,经对症处理后成活;其余皮瓣均顺利成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合,植皮均顺利成活。术后患者均获随访,随访时间6~24个月,平均13个月。皮瓣外观满意,质地与健侧相似,皮瓣恢复保护性感觉;术后6个月两点辨别觉为15~28 mm,平均19.5 mm。供区无瘢痕挛缩,双下肢功能均正常。结论改良股前外侧游离穿支皮瓣采用健侧胫前/后血管桥式交叉供血,血供可靠,供区损伤小,是修复小腿中下段大面积软组织缺损伴主干血管严重损伤的可供选择的修复方式之一。
[Abstract]:Objective to investigate the clinical effect of modified anterolateral thigh perforator flap in repairing soft tissue defect of middle and lower leg. Methods from March 2011 to June 2015, 15 patients with middle and lower leg skin and soft tissue defects were treated. There were 9 males and 6 females, aged 22 to 48 years (mean 32.6 years). The causes of injury were: 8 cases of traffic accident, 5 cases of mechanical injury and 2 cases of heavy object crush injury. The time from injury to admission was 2 hours and 1 week, with an average of 86.2 hours. The defect area was 13 cm 脳 9 cm~23 cm 脳 16 cm. After admission, one stage debridement and negative pressure drainage were performed. In the second stage, modified anterolateral femoral perforator flap bridge was used to repair the wound surface. The skin flap was removed from 15 cm 脳 10 cm~25 cm 脳 15 cm. Direct suture of donor area or repair of free skin graft. The pedicle was broken 4 weeks after repair. Results one case of flap had vascular crisis and 2 cases had necrosis of skin margin and survived after symptomatic treatment. All the other flaps survived smoothly and the wound healed at first stage. All the donor incisions healed in one stage and skin grafts survived successfully. All patients were followed up for 6 ~ 24 months (mean 13 months). The skin flap was satisfactory in appearance, similar in texture to the normal side, and restored to protective sensation, and the discriminative perception at two points was 1528 mm at 6 months after operation, with an average of 19.5 mm. No scar contracture in donor area and normal lower limb function. Conclusion the modified anterolateral thigh free perforator flap has the advantages of good blood supply, reliable blood supply and less injury to the donor area by using the contralateral anterior / posterior tibial artery bridge. It is one of the alternative methods to repair large soft tissue defects in middle and lower leg with severe injury of main vessels.
【作者单位】：扬州大学临床医学院江苏省苏北人民医院手足显微外科;中南大学湘雅医学院骨科;
【分类号】：R658.3

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