摘要
目的探讨旋股外侧动脉降支多叶瓣修复手部多部位软组织缺损的手术方法和临床效果。方法对手部多部位软组织缺损15例，采用旋股外侧动脉降支多叶瓣修复，根据手部缺损情况设计股前外侧皮瓣，沿皮瓣穿支血管向远端继续解剖旋股外侧动脉降支，考虑好手部各缺损处间距．按需切取分叶穿支皮瓣、阔筋膜瓣、股直肌肌瓣、股外侧肌肌瓣、股中间肌肌瓣或旋股外侧动脉降支远端肌间隔瓣。形成以旋股外侧动脉降支为主干的一蒂多叶瓣，在肌瓣及阔筋膜瓣上植皮，一次修复手部多部位软组织缺损。结果术后无血管危象发生。修复各创面在肌瓣、阔筋膜瓣或旋股外侧动脉降支远端血管肌间隔上植皮均成活良好，外形无臃肿，植皮处恢复保护性感觉，供区创面愈合好，股四头肌肌力及膝关节屈、伸活动均正常。全部病例获得随访，随访时间6～20个月，平均8．7个月。按中华医学会手外科学会上肢部分功能评定标准：优3例，良9例，可3例，优良率80％。结论旋股外侧动脉降支多叶瓣能一次修复手部多部位软组织缺损，缩短手术时间及疗程，手部功能恢复良好，外形满意。是修复手部多部位软组织缺损的理想方法。
Objective To introduction of perforator flaps, muscle flaps pedicled by descending branch of lateral circumflex femoral artery, method and their clinical application that multiple soft tissue de- fects of hand are repaire by muliplefoliated tissue flap only branch lateral circumflex femoral artery. Meth- ods Fifteen patients with multiple soft tissue defects of hand were repaired muliplefoliated tissue flap only pedicled by descending branch lateral circumflex femoral artery. At first, the anterolateral thigh perforator flap was designed and harvested according to the soft tissue defects of hand, then the descending branch lat- eral circumflex femoral artery was dissected at the same time the segmented perforator flap, fascia lata flap, rectus femoris muscle flap, vastus lateralis muscle flap, vastus intermedius muscle flap and distal spatium in- termusculare flap were harvested in need according to distance among soft tissue defects. The muliplefoliated tissue flap was harvested only pedicled by descending branch lateral circumflex femoral artery, at last muscle flaps and fascia lata flaps were covered by skin graft, so the multiple soft tissue defects of hand were re- paired in one time. Results No vascular crisis happened. All skin grafts survived well, the contour of all repaired soft tissue defects was good and protective feeling was recovered by skin grafts of all flaps. All cases were got follow-up and the range was from 6 to 20 months （the average was 8.7 months）. Wound of donor site healed well, muscle strength of quadriceps and motion of knee were normal. Three cases were excellent, nine cases were well and 3 cases were good, according to upper extremity function evaluation criteria of Chinese Medical Society for the Surgery of the Hand, the rate of good was 80 percent. Conclusion Multi- ple soft tissue defects of hand can be repaired by muliplefoliated flap only pedicled by descending branch of lateral circumflex femoral artery. Its advantages included reduction of operation time and treatment, good re- covery of hand contour and function. It is a good method to repair multiple soft tissue defects of hand.
出处
《中华显微外科杂志》
CSCD
北大核心
2011年第4期280-282,356,共4页
Chinese Journal of Microsurgery
关键词
手
旋股外侧动脉
组织瓣
显微外科
Hand
Lateral circumflex femoral artery
Tissue flap
Microsurgery
