股前外侧游离皮瓣修复小腿皮肤软组织缺损

发布时间：2018-06-12 11:17

本文选题：股前外侧皮瓣 + 小腿　；参考：《华北理工大学》2017年硕士论文

【摘要】：目的探讨股前外侧游离皮瓣修复小腿皮肤软组织缺损的临床疗效;对股前外侧皮瓣的穿支血管进行临床观测,并将来源于降支和外侧支的穿支血管进行对比分析;为精准切取分叶皮瓣、嵌合皮瓣奠定临床基础,以更好的指导临床应用。方法收集2010年9月至2016年9月期间华北理工大学附属骨科医院小腿皮肤软组织缺损行股前外侧游离皮瓣修复治疗的病例资料32例,男25例,女7例。年龄最小15岁,最大58岁。创面面积5.0cm×12.0cm~12.0cm×22.0cm,皮瓣切取面积7.0cm×15.0cm~13.0cm×25.0cm。受伤至手术时间为12~45天。研究方法:术前用创新的肌间隙血管穿支定位方法,辅以多普勒血流探测仪预先探测动脉搏动点并做好标记,依标记的穿支血管部位及创面缺损面积、深度等大小设计皮瓣,将探测的血管穿支总体设计在皮瓣的中上1/3部的轴线上。术中切开皮瓣探寻穿支并沿血管束进行逆行解剖,显露整个皮瓣血管蒂的情况,观测、记录术中有效穿支与术前探测穿支位置是否一致,穿支与A点位置关系、穿支浅出点外径、穿支起始处外径、穿支类型、肌皮穿支穿肌长度及穿支血管的来源动脉等数据。结果本组行股前外侧游离皮瓣修复的32例皮瓣中,31例完全成活(其中发生血管危象1例);1例远端部分坏死,经皮片移植术后创面愈合。随访5~24月,平均8个月,伤口无再破溃,皮瓣的皮肤颜色较周围正常皮肤无明显差异,皮瓣质地柔软,外形满意,均有不同程度保护性感觉恢复。皮瓣供区未见严重瘢痕,无明显感觉异常,无股四头肌功能障碍。术中共发现穿支血管68支,其中50支用于皮瓣的切取,其中40支(80%)来自降支,10支(20%)来自外侧支(高位皮动脉),探测其切取皮瓣的有效动脉穿支符合率为98%。我们统计并发现50支穿支与A点的位置关系分布如下:外侧支的穿支血管的70%位于A点以近,其余30%位于A点以远;降支穿支血管的65%位于A点以远,12.5%位于A点,22.5%位于A点以近;但所有穿支均位于均位于股直肌与股外侧肌肌间隙及其外侧。旋股外侧动脉降支(或外侧支)起始处至穿支起始处长度9.6cm±3.50cm(6.0cm~15.0cm);穿支肌内走行长度为:8.14cm±0.12cm(5.0cm~10.5cm);出肌点至入皮点(穿支肌外走行)长度:1.95cm±0.09cm(1.0cm~5.5cm);旋股外侧动脉降支(或外侧支)起始处的外径为2.7mm±0.6mm(2.2mm~3.7mm);穿支起始处外径为1.8mm±0.9mm(1.3mm~2.8mm);穿支浅出点处外径为0.6mm±0.1mm(0.4mm~1.2mm)。结论股前外侧皮瓣术是修复小腿皮肤软组织缺损的可靠方法,具有满意的临床疗效;创新的肌间隙定位法辅以多普勒探测技术能够提高术前穿支血管定位的准确率;有效穿支均位于股直肌与股外侧肌肌间隙及其外侧。
[Abstract]:Objective to investigate the clinical effect of free anterolateral femoral flap on repairing skin and soft tissue defects of the leg, to observe the perforating vessels of the anterolateral femoral flap and to compare the perforating vessels from the descending and lateral branches. In order to accurately cut the lobulated flap and chimeric flap to lay a clinical foundation for better guidance of clinical application. Methods from September 2010 to September 2016, 32 cases (25 males and 7 females) with skin and soft tissue defects of the calf treated with anterolateral free thigh flap in affiliated Orthopaedics Hospital of North China University of Science and Technology were collected. The youngest is 15 and the oldest is 58. The wound area was 5.0cm 脳 12.0cm~12.0cm 脳 22.0cm, and the area of flap was 7.0cm 脳 15.0cm~13.0cm 脳 25.0cm. The time from injury to operation was 1245 days. Methods: preoperative localization of perforating branches of intermuscular space was performed with Doppler blood flow detector to detect the pulsatile point of the artery, and the flap was designed according to the area and depth of the defect of the perforating vessel and wound surface. The detected perforating branch is designed on the axis of the middle and upper third of the flap. The perforating branch was explored and dissected retrograde along the vascular bundle during the operation. The vascular pedicle of the whole flap was exposed. The position of the effective perforating branch was the same as the position of the perforating branch detected before operation, and the relationship between the perforating branch and the A point position was recorded. The external diameter of perforating branch, the origin of perforating branch, the type of perforating branch, the length of perforator muscle and the origin artery of perforating branch. Results among 32 cases of free femoral flap repaired, 31 cases survived completely (including 1 case with vascular crisis and 1 case with partial necrosis of distal end), and the wound healed after percutaneous grafting. Follow up for 5 ~ 24 months (mean 8 months) showed that there was no re-rupture of the wound, the skin color of the flap was not significantly different from that of the surrounding normal skin, the skin texture of the flap was soft, the appearance was satisfactory, and the skin flap had different degree of protective sensory recovery. There was no severe scar, no obvious sensory abnormality and no dysfunction of quadriceps femoris in the donor area of the flap. A total of 68 perforating vessels were found during the operation, of which 50 were used for the removal of the flap, of which 40 were from the descending branch (10 / 20) and 20 were from the lateral branch (superior cutaneous artery). The coincidence rate of detecting the effective perforating branch of the flap was 98. The relationship between 50 perforating branches and point A was found to be as follows: 70% of the perforating vessels of the lateral branch were located near point A and the other 30% were located in the distance from point A. 65% of descending branch perforators were located at point A, 12.5% at point A and 22.5% near point A, but all perforators were located in the space between rectus femoris and lateral muscle of femoris. The length of descending branch (or lateral branch) of lateral circumflex femoral artery (or lateral branch) is 9.6cm 卤3.50 cm ~ 6.0 cm ~ (-1) ~ 15.0 cm ~ (-1); the length of intramuscular walk of perforating branch is 8.14 cm 卤0.12 cm ~ 5.0 cm ~ (10.5 cm); the length of muscle exit point is 1.95 cm 卤0.09 cm ~ (1.0) cm ~ (1.5 cm); the origin of descending branch of lateral femoral artery (or lateral branch) is 1.95 cm 卤0.09 cm ~ (1.0) cm ~ (1.5 cm). The external diameters of the perforating branches were 2.7mm 卤0.6mm / 2.2mm / 3.7mm, 1.8mm 卤0.9mm / 1.3mm / 2.8mm and 0.6mm 卤0.1mm / 0.4mm / 1.2mm / mm respectively. Conclusion the anterolateral femoral flap is a reliable method for repairing the skin and soft tissue defect of the lower leg and has a satisfactory clinical effect. The effective perforating branches were located in the space between the rectus femoris muscle and the lateral femoral muscle.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R658.3

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