摘要
目的探讨旋股外侧动脉降支皮瓣的个体化设计及供瓣区的生态保护。方法根据四肢创面的特点，结合旋股外侧动脉降支穿支血管的解剖，切开皮瓣的内侧皮肤在阔筋膜表面寻找2条穿支血管并进行穿支追踪，根据穿支的粗细灵活调整KISS皮瓣的大小。根据肌肉穿支的入肌点及穿支的粗细、股神经的位置调整嵌合皮瓣肌瓣的切取，保护供瓣区的神经及肌肉。在切取皮瓣的同时保留供瓣区的阔筋膜、神经及肌肉组织，减少供区的破坏，同时皮瓣切取后重建供区的生态结构。共治疗33例患者，男22例，女11例，年龄13-71岁，平均47岁。上肢手背及腕部创面21例，足背及下肢创面12例。创面面积7cm×8cm-13cm×24cm，皮瓣面积6cm×7cm-8cm×15cm，KISS皮瓣22例，嵌合皮瓣11例，供区均直接缝合，病程1周至2个月。结果术中切取皮瓣顺利，术后皮瓣均jl~,lJ成活，无血管危象产生，创面一期愈合。28例获3-24个月随访，平均18个月，皮瓣色泽、质地良好，外形满意，恢复保护性感觉，供区仅留下线状瘢痕，供瓣区无肌疝及运动障碍等。结论通过术中穿支血管的粗细决定KISS皮瓣的大小，根据肌肉穿支的粗细及人肌点，结合受区的需求调整嵌合皮瓣肌瓣的切取，达到创面的个性化修复。皮瓣切取过程中注意保护供区阔筋膜、皮神经、运动神经及肌肉。在合理利用供瓣区的同时，重建供区的生态结构，避免了浪费，减少了并发症。
Objective To summarize the individual design of the perforator flap based on the descending branch of the lateral circumflex femoral artery and ecological protection of the flap. Methods From June 2013 to June 2017, 33 cases of extremities wound defects were repaired with the descending branch perforator flap of the lateral circumflex femoral artery. According to the chracteristics of extremity wound and the anatomy of the descending branch perforator of the lateral circum flex artery, a medial incision of the flap according to the demarcation line was performed. Through meticulous dissection, two perforator branches were found and traced on the surface of facia lata. The size of the kiss flap was adjusted according to the perforator caliber. The chimeric muscular flap was incised according to muscular penetration point of the perforator and the course of lateral fermoral nerve with cautious protection of muscular branch of femoral nerve. During the incision, fascia lata, nerves and muscles on donor site were protected to reduce the damage to donor site. Meanwhile, ecological structure on donor site was reconstructed. Our series include 22 males, 11 females. The average age ranged from 13 to 71 years （mean： 47years）. There were 21 cases of wounds on dorsum manus and wrists and 12 cases of wounds on the dorsum pedis and lower limbs. The wound dimension ranged from 7 cm x 8 cm to 13 cmx 24 cm. The flap dimension ranged from 6 cm x 7 cm to 8 cm x 15 cm. There were 22 cases of KISS flaps and 11 cases of chimeric flaps. Wounds on all donor sites were primarily sutured. Course of the disease ranged from 1 week to 2 months. Results All flaps were harvested uneventfully and survived well. No vascular crisis occurred. Wounds on all donor sites were primarily sutured. Three to 24 （mean 18） months of follow-up was made on 28 cases. The color and texture of flaps was good. Appearance of the flaps was good. Protective sensation recovered. Only linear scar can be seen on donor sites. No muscular hernia and cinesipath
作者
唐修俊
王达利
魏在荣
王波
张子阳
吴必华
陈伟
Tang Xiujua;Wang Dali;Wei Zairong;Wang Bo;Zhang Ziyang;Wu Bihua;Chen Wei(Department of Burn and Plastic Surgery,Affiliated Hospital of Zunyi Medical College,Zunyi 563003,China)
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2018年第7期509-514,共6页
Chinese Journal of Plastic Surgery
基金
国家临床重点专科基金（国卫办医函[2013]544）
关键词
外科皮瓣
创面修复
个性化设计
供瓣区生态保护
Sargical flap
Wound surface repair
Individualized design
Ecologicalprotection in flap-supply area
