摘要
目的:探讨以旋股外侧动脉斜支为源动脉的股前外侧双叶穿支皮瓣修复四肢创面的可行性及临床疗效。方法:2014年12月至2020年5月,采用以旋股外侧动脉斜支为源动脉的股前外侧双叶穿支皮瓣修复四肢创面36例,其中6例为同一肢体上相邻但不连续的2处创面,面积4.0 cm×5.0 cm~11.0 cm×9.0 cm;30例为单个创面,面积10.0 cm×10.0 cm~23.0 cm×17.0 cm。常规行术前CDU穿支定位78条穿支,实际切取67条穿支。根据术中实际穿支情况进行分叶设计,完全型双叶皮瓣19例,采用皮肤分叶深筋膜相连的筋膜型双叶皮瓣17例。皮瓣的血液循环重建均采用旋股外侧动脉斜支与受区血管吻合,采用血流桥接型吻合方式8例。所有大腿供区均Ⅰ期缝合。术后定期复查。结果:本组35例双叶皮瓣顺利成活,1例修复2处创面者皮瓣发生静脉危象,经拆除部分缝线,皮瓣表面切口放血7 d后成活。大腿供区均Ⅰ期愈合,伤口愈合时间为11~83 d。术后随访6~39个月,皮瓣色泽、质地良好,感觉恢复为S 2~S 3。供区除1例瘢痕面积较大外均为线形瘢痕存留,未出现瘢痕挛缩及疼痛等不适,无其他严重并发症发生。结论:应用以旋股外侧动脉斜支为源动脉的股前外侧双叶穿支皮瓣修复四肢创面,在体现双叶皮瓣优势的同时,供区更加隐蔽,可以成为旋股外侧动脉降支不能切取双叶皮瓣时的有益补充。
Objective To investigate the feasibility and clinical efficacy of the bilobed anterolateral femoral perforator flap pidicled with the oblique branch of lateral femoral circumflex artery in repair of the wounds in extremities.Methods A study was conducted on 36 patients with complex limb wounds from December,2014 to May,2020.Thirty patients had single-wound sized from 10.0 cm×10.0 cm to 23.0 cm×17.0 cm,and 6 patients had 2 adjacent and discontinuous wounds sized from 4.0 cm×5.0 cm to 11.0 cm×9.0 cm.A total of 78 perforators were identified in routine preoperative CDU examination,and 67 perforators were confirmed.According to the actual requirement of the perforator confirmed in surgery,19 flaps were designed with completely split up into bilobed flaps and 17 bilobed fascial flaps were designed with segmented skin and deep fascia.The blood supply of flaps relies on the anastomosis of oblique branch with the recipient vessels,therefore bridged blood Flow-through anastomosis was performed in 8 flaps.All thigh donor sites were sutured directly.Regular follow-up were made after surgery.Results In this group,35 cases of bilobed flaps survived successfully.Venous crisis was found in 1 case of flap repairing 2 wounds after the operation and was relieved 7 days later by remove some stitches and bloodletting.The donor sites healed by first intension,and the wound healing time was 11-83 days.All patients were followed-up for 6-39 months.The flaps had good colour and texture with S2-S3 sensory.All the donor sites left linear scars except 1 where left with a large scar without contracture and pain.Conclusion The repair of the wounds in extremities by bilobed anterolateral thigh perforator flaps pedicled with the oblique branch of the lateral femoral circumflex artery could obtain a more concealed donor site.It acts as a beneficial supplement when a bilobed flap cannot be harvested on the descending branch of the lateral femoral circumflex artery.
作者
柳志锦
巨积辉
程俊楠
杨林
刘胜哲
张韬
侯瑞兴
LIU Zhijin;JU Jihui;CHENG Junnan;YANG Lin;LIU Shengzhe;ZHANG Tao;HOU Ruixing(Department of Hand Surgery,Ruihua Affiliated Hospital of Soochow University,Suzhou,Jiangsu Province 215104,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2021年第2期152-156,共5页
Chinese Journal of Microsurgery
基金
江苏省青年医学人才项目(QNRC2016224)
江苏省研究生科研与实践创新计划项目(SJCX20_1076)
苏州市姑苏卫生人才计划项目(2020075)
苏州市民生科技项目关键技术应用研究(SS202092)
苏州市卫生科教临床重点病种诊疗技术专项(LCZX202026)
苏州市企业工程技术研究中心专项(SZS2019263)。
关键词
股前外侧穿支皮瓣
斜支
旋股外侧动脉
双叶皮瓣
修复
四肢
Anterolateral thigh perforator flap
Oblique branch,lateral femoral circumflex artery
Bilobed flap
Repair
Extremity
