游离双侧股前外侧穿支皮瓣串联修复足、踝关节大面积软组织缺损

中华显微外科杂志 Pub Date : 2018-10-25 DOI:10.3760/CMA.J.ISSN.1001-2036.2018.05.009

Huanwei Sun, Yiming Zhong, Hongquan Zhang

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引用次数: 0

摘要

目的探讨游离双侧股前外侧穿支皮瓣修复足、踝大面积软组织缺损的临床效果。方法2013年7月至2017年12月，对30例踝关节和足部较大软组织缺损患者(男19例，女11例)进行手术治疗，年龄21 ~ 52岁。缺损部位位于足、踝关节中远端，创面均有骨、肌腱或内固定器外露，皮肤缺损面积为15 cm× 22 cm ~ 19 cm× 28 cm。所有病例均采用游离双侧股前外侧穿支皮瓣修复。术前采用CDU或DSA确定双侧皮瓣穿支。根据皮肤缺损面积和创面形态，在大腿前外侧设计合适的穿支皮瓣。采用一个穿支皮瓣作为近端串联皮瓣，近端血管蒂与受体区动静脉皮瓣吻合。另一个穿支皮瓣作为远端系列皮瓣，在两个皮瓣之间吻合动静脉。两个皮瓣的总面积为17 cm × 25 cm-23 cm × 32 cm。观察皮瓣存活及修复部位功能恢复情况，并评价其临床效果。结果术后无血管危象，皮瓣成活。随访5 ~ 28个月(平均13.5个月)，皮瓣血流良好，质地柔软，弹性好，其中4例轻度肿胀，整形术后改善。术后优26例(90 ~ 100分)，良4例(75 ~ 89分)，AOFAS评分平均93.8分。结论总结了前外侧穿支的交通事故及皮瓣切开和缝合过程中的注意事项。关键词:足部;脚踝;股前外侧穿支皮瓣;修理;显微外科手术

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Repair the large area soft tissue defect of foot and ankle with free bilateral anterolateral femoral perforator flap in series

Objective To investigate the clinical effect of free bilateral anterolateral femoral perforator flap in repairing large area soft tissue defects of foot and ankle. Methods From July, 2013 to December, 2017, 30 patients(19 males and 11 females) with large soft tissue defects of ankle and foot were treated, aged 21-52 years. The defects were located in the middle and distal part of the foot and ankle, the wounds were all exposed with bone, tendon or internal fixator, and the area of skin defect was 15 cm × 22 cm-19 cm× 28 cm. All of them were repaired by free bilateral anterolateral femoral perforator flaps. The perforating branch of bilateral flap was determined by CDU or DSA before operation. According to the area of skin defect and the shape of wound, an appropriate perforating branch flap was designed in the anterolateral thigh region. One perforating branch flap was used as the proximal series flap, the proximal vessel pedicle was anastomosed with the recipient region arteriovenous flap. The other perforating branch flap was used as the distal series flap, the artery and vein were anastomosed between the two flaps. The total area of the two flaps was 17 cm × 25 cm-23 cm × 32 cm. The survival of the flap and the functional recovery of the repair site were observed and the clinical effect was evaluated. Results There was no vascular crisis after operation, and the flaps survived. Followed-up for 5-28(mean, 13.5)months showed that the flap had good blood flow, soft texture and good elasticity, among which 4 cases were slightly bloated and improved after plastic operation. After operation, 26 cases were excellent(90-100 points), 4 cases were good(75-89 points), and the average score of AOFAS was 93.8 points. Conclusion The traffic accident of anterolateral perforating branch and the attention in the process of flap cutting and series were summarized. Key words: Foot; Ankle; Anterolateral femoral perforator flap; Repair; Microsurgical operation

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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.