摘要
目的探讨分叶式股前外侧嵌合穿支皮瓣在修复四肢复杂性软组织缺损中的应用方法与手术效果。方法回顾2013年10月至2020年10月治疗的52例四肢复杂性软组织缺损的患者资料,其中男32例,女20例;年龄6~65岁,平均39岁。缺损原因:交通意外伤17例,机器挤压伤15例,工程意外伤12例,恶性肿瘤扩大切除术后8例。软组织缺损面积为:26.0 cm×10.0 cm~35.0 cm×15.0 cm。根据软组织缺损和肢体远端血液循环情况设计分叶式股前外侧嵌合穿支皮瓣或分叶Flow-through式嵌合穿支皮瓣。术后8个月开始根据中华医学会手外科学分会上肢功能评定试用标准和臂肩功能障碍(DASH)评分表对上肢功能进行评定,根据Fugl-Meyer下肢评定量表对下肢功能进行评定。并采用微信视频和门诊预约复查的方式对患者进行长期随访。结果所有皮瓣全部成活。其中1例挤压伤患者因术后深部血肿导致伤口延迟愈合,其余均一期愈合。本组患者均获术后随访,随访时间6~20个月,平均8个月;皮瓣外观满意,颜色与受区无显著差异;肿瘤患者随访期间无复发病例报告;根据中华医学会手外科学分会上肢功能评定试用标准评定,优21例,良8例,优良率100%。最后一次随访DASH上肢肢功能评分11.5~45.1(25.4±13.7)分;Fugl-Meyer下肢功能评分18.6~31.8(26.2±11.2)分。结论采用分叶式股前外侧嵌合穿支皮瓣通过"分解-组合排列"的方法进行移植修复,手术设计灵活,仅吻合一组血管蒂即可获得多样性的组织瓣,是修复四肢复杂性软组织缺损的理想选择。
Objective To investigate the application and surgical effect of lobed anterolateral femoral chimeric perforator flap in repairing the complex soft tissue defects of limbs.Methods Clinical materials of 52 cases with complex soft tissue defects of limbs were retrospectively reviewed from October 2013 to October 2020.Thirty-two males and 20 females were reviewed,and the age of them ranged from 6 to 65(mean 39)years old.The injuries include 17 cases of traffic accidents,15 machine crush injuries,12 engineering accidents,and 8 extensive resection of malignant tumors.The size of soft tissue defects ranged from 26.0 cm×10.0 cm to 35.0 cm×15.0 cm.Lobed anterolateral thigh chimeric perforator flaps or lobed Flow-through chimeric perforator flaps were designed according to the soft tissue defects and blood circulation of the distal extremities.Start from 8-month post-operation,upper limb function was assessed according to the Upper Limb Function Assessment Standard of Hand Surgery Branch of Chinese Medical Association and Disability of arm shoulder and hand(DASH)score scale,and Fugl-Meyer score system was used to evaluate the lower limb function.Long-term follow-up was conducted through WeChat video call and outpatient clinic evaluation.Results All flaps survived.One patient with crush injury got delayed wound healing due to deep hemaetoma after surgery,and the rest were healed at the first stage.All the cases entered followed-up,ranged from 6 to 20(mean 8)months.The appearance of the flaps was satisfactory,and the color of the flaps has no significant difference compared with the recipient area.No recurrence of tumor was reported during the follow-up period.According to the Upper Limb Function Assessment Standard of Hand Surgery Branch of Chinese Medical Association,there were 21 excellent cases and 8 good cases,and the total excellent and good rate was 100%.The DASH score of upper limbs ranges from 11.5 to 45.1(mean 25.4±13.7),and the Fugl-Meyer score of lower limbs range from 18.6 to 31.8(mean 26.2±11.2)at the last
作者
臧成五
陈永祥
鲜航
赵长应
张建磊
邹庆洋
朱愉乐
丛锐
ZANG Chengwu;CHEN Yongxiang;XIAN Hang;ZHAO Changying;ZHANG Jianlei;ZOU Qingyang;ZHU Yule;CONG Rui(Department of Hand Surgery,Xijing Hospital,The Air Force Medical University,Xi’an 710032,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2022年第3期254-259,共6页
Chinese Journal of Microsurgery
基金
空军军医大学附属西京医院学科助推计划(XJZT19ML07)。
关键词
股前外侧嵌合穿支皮瓣
四肢
软组织缺损
显微外科技术
Anterolateral femoral chimeric perforator flap
Limbs
Soft tissue defect
Microsurgical technique
