摘要
目的探讨应用自浅筋膜浅、深交界层逆行分离穿支血管的超薄分叶股前外侧穿支皮瓣(ALTPF)修复足部大面积软组织缺损的临床疗效。方法2021年8月至2022年11月,大连理工大学附属中心医院手足外二科收治足部大面积软组织缺损的患者8例,男5例,女3例;年龄28~52岁。软组织缺损位于足背及足底部,足底部创面均累及负重区,创面均合并骨、肌腱或内固定物外露,软组织缺损面积6.0 cm×5.0 cm~16.0 cm×8.0 cm,所切取ALTPF面积8.0 cm×5.5 cm~18.0 cm×8.5 cm,均为分叶皮瓣。术前采用高频CDU结合CTA造影确定2条皮瓣穿支血管,以此为中心,根据软组织缺损面积及创面形状,于大腿股前外侧区域设计一适宜面积及形状的穿支皮瓣,切取皮瓣过程中,于浅筋膜浅、深交界层逆行分离穿支血管,可明显削薄皮瓣厚度,切取后根据创面形状,在确保2条穿支血管均供血有效后,于2条穿支之间进行分叶,最后覆盖于足部创面,并保证皮瓣覆盖足底负重区。皮瓣供区处理情况:8例患者供区均直接予以缝合。术后定期随访,随访方式包括门诊复诊、微信联系或电话询问等。观察皮瓣成活情况及修复部位的功能恢复情况,并评价临床效果。根据美国矫形足踝协会(AOFAS)踝-后足评分量表评价足踝部运动功能恢复情况。结果所移植8例ALTPF全部成活。随访6~18个月,平均10.8个月,所移植皮瓣血运良好,质地柔软,弹性好,外观菲薄。皮瓣供区随访情况:外形及功能均恢复良好,1例患者瘢痕轻度增生。足底皮瓣耐磨程度佳,无患者诉行走后皮瓣出现破损、出血、肉芽组织增生的情形。AOFAS踝-后足评分,平均分为95.6分。结论应用自浅筋膜浅、深交界层逆行分离穿支血管的超薄分叶ALTPF修复足部大面积软组织缺损具有良好的临床疗效。
Objective Exploring the clinical efficacy of using ultra-thin lobulated anterolateral thigh perforator flap(ALTPF)with retrograde separation of perforating vessels from the superficial and deep junction layer of the superficial fascia to repair large soft tissue defects in the foot.Methods From August 2021 to November 2022,8 patients(5 males and 3 females)were admitted to the Second Department of Hand and Foot Surgery,the Affiliated Central Hospital of Dalian University of Technology.The patients were 28 to 52 years old in age.The soft tissue defects were located in dorsal and plantar foot.At the plantar foot,the wound involved the weight-bearing area with explosion of bone,tendon or internal fixtures.The area of soft tissue defects was 6.0 cm×5.0 cm-16.0 cm×8.0 cm,and the sizes of ALTPF were 8.0 cm×5.5 cm-18.0 cm×8.5 cm.Preoperative high frequency CUD combined with CTA angiography were employed to locate the 2 flap perforator vessels.By keeping the perforator vessels at center and according to the soft tissue defect area and the wound shape,an ALTPF with a proper size and shape was designed in anterolateral thigh.The perforator were separated in the boundary layer between superficial and deep fascia,where it helped to obviously thin the flap.After the flap was harvested,it was further lobulated between the 2 perforators into 2 lobes after having confirmed the effective blood supply.Finally the lobulated ALTPF was transferred to covered the defect in foot.Cautions should be taken to ensure that the flap covered the weight-bearing area of foot.All the donor sites were directly sutured.Postoperative follow-up was conducted to observe the survival of flaps and the functional recovery of the reconstructed site,also to evaluate the clinical effect.Postoperative follow-up included outpatient visits and reviews over WeChat or telephone.Recovery of the ankle motor function was evaluated according to the American Orthopedic Foot and Ankle Societ(AOFAS)ankle-hind foot score scale.Results All 8 ALTPF survived.Over 6 to 18 months(10.8 months in average)of follow-up,the transferred flaps had good blood supply,soft in texture,with good elasticity and thin in appearance.Appearance and function of donor sites recovered well,except 1 patient who had mild scar hyperplasia.The plantar flap had good abrasion resistance.No flap damage,bleeding or granulation tissue hyperplasia occurred when walking.The mean score of AOFAS ankle-hind foot score achieved 95.6.Conclusion The application of ultra-thin lobulated ALTPF with retrograde separation of perforating vessels from the superficial fascia at the junction layer for repairing large soft tissue defects in the foot has good clinical efficacy.
作者
孙焕伟
钟怡鸣
苏毅
高斌
王春生
邹啸威
孙阳
张洪权
杨卫东
汤欣
SUN Huanwei;ZHONG Yiming;SU Yi;GAO Bin;WANG Chunsheng;ZOU Xiaowei;SUN Yang;ZHANG Hongquan;YANG Weidong;TANG Xin(Second Department of Hand and Foot Surgery,the Affiliated Central Hospital of Dalian University of Technology,Dalian,Liaoning Province 116033,China;Department of Traumatic Orthopaedics,the First Affiliated Hospital of Dalian Medical University,Dalian,Liaoning Province 116000,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2023年第3期260-266,共7页
Chinese Journal of Microsurgery
关键词
股前外侧穿支皮瓣
浅筋膜层
逆行分离
分叶皮瓣
显微外科手术
Anterolateral thigh perforator flap
Superficial layer
Retrograde separation
Lobulated flap
Microsurgical operation
