摘要
目的探讨术前穿支定位技术辅助下设计股前外侧分叶穿支皮瓣移植修复前臂及手部大面积软组织缺损的临床疗效。方法采用回顾性病例系列研究分析2013年1月-2017年8月无锡市第九人民医院收治的24例前臂及手部软组织缺损患者,其中男18例,女6例;年龄31-68岁,平均52.3岁。创面缺损面积11 cm×10 cm-18 cm×14 cm。均采用股前外侧分叶穿支皮瓣完成修复,术前采用CT血管造影(CTA)联合彩色多普勒超声(CDS)相结合的方法对其穿支进行定位,根据定位穿支及创面情况选择合适的一侧大腿设计分叶皮瓣,将长度转化为宽度后保证所有皮瓣供区Ⅰ期缝合。患者均为Ⅱ期修复,修复时间为5—29 d,平均13 d。术中观察穿支定位准确性(误差不超过1 cm为定位准确);术后2周内观察皮瓣成活和并发症发生情况。随访采用皮瓣功能7项检查指标对疗效进行评价。结果穿支定位准确率为99%。Ⅰ例皮瓣近端约2 cm坏死,2例皮瓣术后出现动脉危象,积极探查后存活。2例术后皮瓣周围伤口感染不愈合,1例换药后愈合,1例再次行清创术后愈合。皮瓣供区均Ⅰ期直接缝合,1例供区瘢痕增生明显。2例手部皮瓣患者后期行皮瓣修薄。24例患者均获随访7-33个月,平均18.3个月。按皮瓣功能7项检查指标进行评定优7例,良13例,可3例,差1例,优良率为83%。末次随访时皮瓣质地均较柔软,色泽良好。结论采用股前外侧分叶穿支皮瓣修复前臂及手部宽度较大的软组织缺损,可转化长度为宽度,供区直接缝合,良好覆盖创面并减少并发症;术前穿支定位技术能实现皮瓣的术前指导设计及术中快速而精确切取。
Objective To assess the clinical efficacy of perforators positioning technique in anterolateral thigh perforator sub lobe flap transplantation for reconstructing soft tissue defects of forearm or hand.Methods A retrospective case series study was performed to analyze 24 patients with forearm and hand soft tissue defects admitted from January 2013 to August 2017.There were 18 males and six females,aged 31-68 years(mean,52.3 years).The wound defect areas ranged from 11 cm×10 cm to 18 cm×14 cm.The anterolateral thigh sub lobe perforator flaps were used for repair.CT angiography(CTA)combined with color Doppler ultrasound(CDS)was used to determine the perforator position before operation.After the appropriate thigh side was selected according to the perforator position and the wound area,the lobed flaps were designed to ensure all the flaps for the stageⅠsuture after the length was converted into width.All patients obtained stageⅡrepair,and the repair time was 5-29 days,with an average of 13 days.The accuracy of perforation positioning was observed during operation(the error was not more than 1 cm for accurate positioning).The flap survival and complications were recorded within 2 weeks after operation.Follow-up was performed using the seven indicators of flap function to evaluate the efficacy.Results The positioning accuracy rate was 99%.One case was seen necrosis about 2 cm at the proximal end of flap.Two cases had arterial crisis after flap operation and survived after active exploration.In two nonunion cases because of wound infection around the flap,one case was healed after dressing change,and another case was healed after debridement.The donor site of the flap obtained stageⅠdirect suture,and one case was seen obvious scar hyperplasia at the donor site.Flaps were made thinner in two patients with hand defects at the later stage.All 24 patients were followed up for 7-33 months,with an average of 18.3 months.According to the seven indexes of the flap function,the results were excellent in seven cases,good in 13,fair in three,and poor in once,with an excellent and good rate of 83%.The flaps appeared soft with good color at the last follow-up.Conclusions In the treatment of soft tissue defects of forearm or hand using anterolateral thigh flap,conversion from length to width and direct suture of donor site can cover the wound well and reduce complications.Perforators positioning technique can facilitate precise preoperative planning and intraoperative accurate cutting.
作者
康永强
吴永伟
马运宏
刘军
杨通
顾珺
惠涛涛
徐鹏
林芳
芮永军
Kang Yongqiang;Wu Yongwei;Ma Yunhong;Liu Jun;Yang Tong;Gu Jun;Hui Taotao;Xu Peng;Lin Fang;Rui Yongjun(Department of Trauma Orthopedics,9th People's Hospital of Wuxi,Wuxi 214062,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2018年第10期886-891,共6页
Chinese Journal of Trauma
基金
江苏省卫生计生委面上项目(H2017077)
关键词
软组织损伤
外科皮瓣
外科手术
计算机辅助
股前外侧皮瓣
Soft tissue injuries
Surgical flaps
Surgery
computed tomography
Anterolateral thigh flap
