摘要
目的探索应用吻合血管的游离皮瓣,修复小腿及足部大面积皮肤软组织缺损的治疗方法,分析皮瓣发生血管危象的原因,提出预防血管危象产生的方法。方法采用肩胛皮瓣、股前外侧筋膜皮瓣、腹壁下动脉穿支皮瓣,修复小腿及足部皮肤软组织缺损15例。病变缺损面积4.5cm×8.0cm^10.0cm×21.0cm,皮瓣切取范围5.5cm×9.0cm^12.0cm×24.0cm。对应用游离皮瓣修复小腿及足部缺损的可行性、皮瓣选用原则以及并发症发生原因等进行了讨论。结果共治疗15例患者,15个游离皮瓣中,5个皮瓣出现静脉性血管危象。最终11个皮瓣全部成活,3个皮瓣远端有局部坏死,1个皮瓣完全失活。8例患者随访3~12个月,形态功能较满意。结论游离皮瓣修复小腿及足部皮肤软组织缺损,易发生血管危象,需要慎重选择病例,在受区具有理想的血管条件并具备熟练的显微外科技术的前提下,才可以获得较高的皮瓣成活率和良好的手术效果。
Objective To explore a method of repairing large area skin and soft tissue defects in legs and feet with free vascularized flaps, to analyze why blood vessel crisis occurs and how to prevent it. Methods Fivty- five free flaps induding scapular flaps, anterolateral thigh flaps, deep inferior epigastric perforator flaps were chosen to repair defects in the leg and foot. The defect area was 4.5 cm × 8.0 cm～10.0 cm × 21.0 cm, and the area of cut flap was 5.5 cm × 9.0 cm～12.0 cm × 24.0 cm. Feasibility of the surgery, selecting principles of flaps and reasons of complication are discussed. Results Fivteen cases were treated with this method. Among 15 free flaps, 5 had blood vessel crisis, Finally 11 were completely survival, 3 had distal skin necrosis, and 1 totally failed. Shapes and function were satisfactory after 3～12 raonths follow- up. Conclusion Blood vessel crisis tends to occur in the repair of leg and foot defects with free flaps, thus it is necessary to select patients carefully. Only under a good blood vessel condition of the area to be operated and with mature microsurgery technique, can a high survival rate of flaps and good surgery effects be obtained.
