摘要
目的探讨游离股前外侧嵌合穿支皮瓣在修复下肢复杂软组织缺损中的应用。方法2015年1月至2019年6月,应用游离股前外侧嵌合穿支皮瓣修复下肢复杂软组织缺损76例,其中小腿29例,足踝部47例,均存在不同程度的组织坏死、感染、深部组织缺损及骨科植入物外露。创面大小为15 cm×8 cm^35 cm×20 cm,其中45例合并死腔形成,62例合并同一部位骨折,38例合并其他部位骨折或其他系统损伤。创面经彻底清创及VSD治疗,待肉芽生长良好、感染控制后,设计并切取以旋股外侧动脉降支为蒂的股前外侧嵌合穿支皮瓣,其中穿支皮瓣修复大部分深部组织裸露的创面,肌瓣填塞死腔和(或)覆盖部分皮瓣周围的创面,在肌瓣上一期或二期游离皮片植皮,术后定期随访。结果本组74例皮瓣完全成活,2例术后72 h内出现血管危象,经及时手术探查处理后好转。1例皮瓣术后渗血过多,予手术止血。4例皮瓣远端或肌瓣上植皮区部分坏死,2例经再次植皮,2例经积极换药后均完全消灭创面。另16例外伤后骨髓炎伴骨缺损,于伤口愈合后3~6个月采用植骨、骨搬运或Masquelet技术进行修复。术后伤口一期愈合68例,延期愈合8例。除5例失访外,71例随访9~24(平均16)个月,患肢外观与功能恢复满意,未出现感染复发。结论采用股前外侧嵌合穿支皮瓣移植时,可以利用穿支皮瓣修复深部组织外露的创面,肌瓣填塞深部死腔和(或)创面并在肌瓣上植皮,仅需吻合旋股外侧动脉降支血管,即可实现肢体复杂创面的三维立体有效修复与重建,是修复下肢复杂创面安全有效的技术方法,适合临床推广应用。
Objective To investigate the application of anterolateral thigh chimeric perforator flap in repairing complex soft tissue defects in lower extremities.Methods From January,2015 to June,2019,76 cases of complex soft tissue defects in lower extremities were repaired with free anterolateral thigh chimeric perforator flap pedicled with the descending branch of lateral circumflex femoral artery,including 29 cases in shank and 47 cases in ankle,and all had various tissue necrosis,infection,deep tissue defect and orthopaedic implant exposure.The size of the wound ranged from 15 cm×8 cm to 35 cm×20 cm,in which 45 cases associated with dead cavity formation,62 cases with combined fractures at the same site,and 38 cases with combined fractures or other system injuries in other sites.After debridement,VSD treatment,good wound granulation and infection control,the chimeric perforator flap pedicled with the descending branch of the circumflex lateral femoral artery was designed and harvested.The perforator flap was used to repair most of the wounds with deep tissue exposures,the muscle flap was used to fill the dead cavity and(or)cover the wound around the flap,and free skin was grafted of the muscle flap at the first or second stage.Scheduled follow-up was conducted after the operation.Results All 76 flaps survived,including vascular crisis occurred in 2 cases within 72 hours after surgery and ceased after immediate surgical exploration.One case had a further surgical operation due to excessive bleeding.Partial necrosis occurred at the distal end of the flap or the skin graft area of the muscle flap in 4 cases,of which 2 cases were treated with grafted skin again and the other 2 cases completely eliminated the wound after active dressing change.Other 16 cases of post-traumatic osteomyelitis with bone defect were repaired respectively with bone grafting,bone transportation or Masquelet technique in 3 to 6 months after wound healing.Among the 76 cases,68 cases had primary wound healing while 8 cases delayed.Seventy-one cases were followed-up from 9 to 24 months,with an average of 16 months,while 5 cases lost.The appearance and function of the affected limbs recovered satisfactorily without recurrence of infection.Conclusion With the anterolateral thigh chimeric perforator flap transplantation,the perforators flap can be conveniently used to repair the wound,and the muscle flap can be used to fill dead cavity and(or)deep wounds with free skin graft.Only the descending branch of lateral circumflex femoral artery is required to be anastomosed.It achieves a 3-dimensional effective reconstruction of the complex wound in extremities.It is a safe and effective technique to repair and reconstruct the complex wound in lower extremities and ideal in clinical applications.
作者
任高宏
吴晓虎
陈允彪
张明敏
REN Gaohong;WU Xiaohu;CHEN Yunbiao;ZHANG Mingmin(Orthopaedics and Traumatology,Department of Orthopaedics,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2020年第5期435-440,共6页
Chinese Journal of Microsurgery
基金
上海王正国创伤医学发展基金(2017KJB-GK-001)
南方医科大学南方医院院长基金重点项目(2017A001)。
关键词
股前外侧穿支皮瓣
嵌合穿支皮瓣
旋股外侧动脉降支
创面修复
深部死腔
Anterolateral thigh perforator flap
Chimeric perforator flap
Descending branch of circumflex lateral femoral artery
Wound repair
Deep dead cavity
