Emergency repair of Gustillo III C limb extremities with free Flow-through chimeric anterolateral thigh perforator flap

中华显微外科杂志 Pub Date : 2020-02-25 DOI:10.3760/CMA.J.ISSN.1001-2036.2020.01.013

Yi Zhan, Ji-cun Tang, Rui-ying Wang, Hai-jun Li, Limin Wang, Bao-shan Wang, Changzhao Huang, X. Xue, Xiaoju Zheng

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引用次数: 0

Abstract

Objective To explore the clinical effects of a single stage reconstruction and revascularization using a free Flow-through chimeric anterolateral thigh perforator (ALTP) flap in Gustillo III C limb injuries. Methods From January, 2010 to December, 2017, 17 patients with Gustillo III C injury of extremities were repaired with Flow-through chimeric ALTP in emergency surgeries. The patients were 16 males and 1 female with mean age of 32.4 (19-55) years. The size of wounds ranged from 16 cm×8 cm-45 cm×30 cm. The injured arteries were Flow-through anastomosed with the descending branch of the lateral circumflex femoral artery to regain blood flow. The deep dead space was filled with vastus lateralis flap, and the skin flap and fascia flap were used for superficial covering. The donor site was closed directly in 6 patients, simultaneous skin grafts were applied in 11 patients. Results The followed-up time ranged 5 to 60 (average 21.8) months, and conducted by clinic visits and by telephone or WeChat interviews. Fifteen flaps survived, and 2 flaps failed with limb amputated. Six patients were repaired with skin and fascia flaps and 11 patients received flaps comprising the skin, fascia and vastus lateralis muscle. Four flaps healed in stage I. Partial necrosis were observed in 11 flaps. Of which, 1 healed by change of dressing and 10 healed by skin grafting. No complications occurred in donor site in all patients. Conclusion The Flow-through chimeric ALTP flap can be used in stage I reconstruction of the blood supply of limbs and meanwhile achieve the 3-D repair of defects. It is one of the reliable methods in the reconstruction of Gustillo III C injuries in the extremities. Key words: Anteriolateral thigh perforator flap; Flow-through; Chimeric flap; Reconstruction; Gustillo type; Microsurgical technique

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嵌合体股前外侧穿支皮瓣急诊修复Gustillo III C型四肢

目的探讨游离股前外侧穿支（ALTP）皮瓣一期重建和血运重建在Gustillo III C型肢体损伤中的临床效果。方法自2010年1月至2017年12月，17例四肢Gustillo III C损伤患者在急诊手术中采用Flow through嵌合ALTP修复。患者为16名男性和1名女性，平均年龄32.4岁（19-55岁）。伤口大小为16cm×8cm～45cm×30cm，损伤动脉采用Flow through与旋股外侧动脉降支吻合，恢复血流。股外侧肌皮瓣填充深部死区，皮瓣和筋膜瓣浅部覆盖。6例患者直接关闭供区，11例患者同时进行皮肤移植。结果随访时间5～60个月，平均21.8个月，采取门诊随访、电话或微信访谈等方式。15个皮瓣存活，2个皮瓣失败，截肢。6名患者使用皮肤和筋膜瓣进行修复，11名患者接受了包括皮肤、筋膜和股外侧肌的皮瓣。I期有4个皮瓣愈合。11个皮瓣出现部分坏死。其中换药愈合1例，植皮愈合10例。所有患者的供区均未发生并发症。结论流式ALTP皮瓣可用于四肢血供的I期重建，同时可实现缺损的三维修复。它是重建四肢GustilloⅢC损伤的可靠方法之一。关键词：股前外侧穿支皮瓣；流经；嵌合皮瓣；重建；Gustillo型；显微外科技术

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来源期刊

中华显微外科杂志

CiteScore

0.50

自引率

0.00%

发文量

6448

期刊介绍： Chinese Journal of Microsurgery was established in 1978, the predecessor of which is Microsurgery. Chinese Journal of Microsurgery is now indexed by WPRIM, CNKI, Wanfang Data, CSCD, etc. The impact factor of the journal is 1.731 in 2017, ranking the third among all journal of comprehensive surgery. The journal covers clinical and basic studies in field of microsurgery. Articles with clinical interest and implications will be given preference.