本文選題：股前外側(cè)穿支皮瓣 + 軟組織缺損�。� 參考：《中國(guó)修復(fù)重建外科雜志》2017年10期

【摘要】：目的探討應(yīng)用改良股前外側(cè)游離穿支皮瓣橋式交叉移植修復(fù)小腿中下段軟組織缺損的臨床療效。方法 2011年3月—2015年6月,收治15例小腿中下段皮膚軟組織缺損患者。男9例,女6例;年齡22~48歲,平均32.6歲。致傷原因:交通事故傷8例,機(jī)器絞傷5例,重物壓砸傷2例。受傷至入院時(shí)間為2 h~1周,平均86.2 h。創(chuàng)面缺損范圍為13 cm×9 cm~23 cm×16 cm。入院后一期清創(chuàng)、負(fù)壓引流治療,二期行改良股前外側(cè)游離穿支皮瓣橋式交叉修復(fù)創(chuàng)面,皮瓣切取范圍15 cm×10 cm~25 cm×15 cm。供區(qū)直接縫合或游離植皮修復(fù)。修復(fù)術(shù)后4周斷蒂。結(jié)果術(shù)后1例皮瓣出現(xiàn)血管危象,2例皮瓣部分皮緣發(fā)生壞死,經(jīng)對(duì)癥處理后成活;其余皮瓣均順利成活,創(chuàng)面Ⅰ期愈合。供區(qū)切口均Ⅰ期愈合,植皮均順利成活。術(shù)后患者均獲隨訪,隨訪時(shí)間6~24個(gè)月,平均13個(gè)月。皮瓣外觀滿(mǎn)意,質(zhì)地與健側(cè)相似,皮瓣恢復(fù)保護(hù)性感覺(jué);術(shù)后6個(gè)月兩點(diǎn)辨別覺(jué)為15~28 mm,平均19.5 mm。供區(qū)無(wú)瘢痕攣縮,雙下肢功能均正常。結(jié)論改良股前外側(cè)游離穿支皮瓣采用健側(cè)脛前/后血管橋式交叉供血,血供可靠,供區(qū)損傷小,是修復(fù)小腿中下段大面積軟組織缺損伴主干血管?chē)?yán)重?fù)p傷的可供選擇的修復(fù)方式之一。
[Abstract]:Objective to investigate the clinical effect of modified anterolateral thigh perforator flap in repairing soft tissue defect of middle and lower leg. Methods from March 2011 to June 2015, 15 patients with middle and lower leg skin and soft tissue defects were treated. There were 9 males and 6 females, aged 22 to 48 years (mean 32.6 years). The causes of injury were: 8 cases of traffic accident, 5 cases of mechanical injury and 2 cases of heavy object crush injury. The time from injury to admission was 2 hours and 1 week, with an average of 86.2 hours. The defect area was 13 cm 脳 9 cm~23 cm 脳 16 cm. After admission, one stage debridement and negative pressure drainage were performed. In the second stage, modified anterolateral femoral perforator flap bridge was used to repair the wound surface. The skin flap was removed from 15 cm 脳 10 cm~25 cm 脳 15 cm. Direct suture of donor area or repair of free skin graft. The pedicle was broken 4 weeks after repair. Results one case of flap had vascular crisis and 2 cases had necrosis of skin margin and survived after symptomatic treatment. All the other flaps survived smoothly and the wound healed at first stage. All the donor incisions healed in one stage and skin grafts survived successfully. All patients were followed up for 6 ~ 24 months (mean 13 months). The skin flap was satisfactory in appearance, similar in texture to the normal side, and restored to protective sensation, and the discriminative perception at two points was 1528 mm at 6 months after operation, with an average of 19.5 mm. No scar contracture in donor area and normal lower limb function. Conclusion the modified anterolateral thigh free perforator flap has the advantages of good blood supply, reliable blood supply and less injury to the donor area by using the contralateral anterior / posterior tibial artery bridge. It is one of the alternative methods to repair large soft tissue defects in middle and lower leg with severe injury of main vessels.
【作者單位】： 揚(yáng)州大學(xué)臨床醫(yī)學(xué)院江蘇省蘇北人民醫(yī)院手足顯微外科;中南大學(xué)湘雅醫(yī)學(xué)院骨科;
【分類(lèi)號(hào)】：R658.3

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