以股内侧穿支为血供来源的股前外侧区皮瓣修复四肢创面的疗效

杨成鹏; 唐林峰; 柳志锦; 刘胜哲; 杨林; 程俊楠; 张韬; 孙丰文; 黄永涛; 高钦锋; 巨积辉

doi:10.3760/cma.j.cn501225-20220726-00310

以股内侧穿支为血供来源的股前外侧区皮瓣修复四肢创面的疗效

doi: 10.3760/cma.j.cn501225-20220726-00310

苏州瑞华骨科医院手外科，苏州　　215104

基金项目:

江苏省青年医学人才项目 QNRC2016224

苏州市姑苏卫生人才计划项目 2020075

苏州市民生科技项目关键技术应用研究 SS202092

苏州市卫生科教临床重点病种诊疗技术专项 LCZX202026

苏州市企业工程技术研究中心专项 SZS2019263

详细信息

通讯作者:
巨积辉，Email：jjh2006@263.net

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出版历程
- 收稿日期: 2022-07-26

Clinical effects of anterolateral thigh flap with blood supply source of medial femoral perforator in repairing the wounds on extremities

Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China

Funds:

Jiangsu Young Medical Talents Project QNRC2016224

Suzhou Gusu Health Talents Plan Program 2020075

Key Technology Application Research of Suzhou Livelihood Science and Technology Project SS202092

Special Project on Diagnosis and Treatment Technology of Clinical Key Disease Species of Health Science and Education in Suzhou LCZX202026

Special Project of Suzhou Enterprise Engineering Technology Research Center SZS2019263

More Information

Corresponding author: Ju Jihui, Email: jjh2006@263.net

摘要

摘要: 目的探讨应用以股内侧穿支为血供来源的股前外侧区皮瓣修复四肢创面的手术方法及临床疗效。方法采用回顾性观察性研究方法。2018年10月—2021年6月，苏州瑞华骨科医院收治12例符合入选标准的在行股前外侧皮瓣切取中未见旋股外侧动脉穿支或因穿支细小改用以股内侧穿支为血供来源进行皮瓣移植修复创面的患者（男11例、女1例，年龄24~64岁），创面位于上肢者7例、位于下肢者5例。清创后的创面面积为8.0 cm×5.0 cm~24.0 cm×6.5 cm，应用的皮瓣面积为9 cm×6 cm~25 cm×7 cm。移植皮瓣时，将皮瓣内穿支或源动脉与受区血管蒂行端端吻合。对供区创面均行皮下减张美容缝合。术后，观察皮瓣成活情况、有无血管危象以及供区创面愈合情况。随访时，观察皮瓣质地、供区创面并发症情况。末次随访时，采用自制改良皮瓣综合疗效评分表评价皮瓣修复效果。结果术后，患者皮瓣均成活，未发生血管危象；供区创面均顺利愈合。随访6~26个月，皮瓣质地优良；供区创面仅遗留线性瘢痕，无瘢痕挛缩或疼痛等不适。末次随访时，12例患者皮瓣修复效果的总得分为75～95分，平均为87分，其中评定为优者5例、良者6例、可者1例，优良患者占比为11/12。结论应用以股内侧穿支为血供来源的股前外侧区皮瓣修复四肢创面，是股前外侧皮瓣切取过程中遇到无旋股外侧动脉降支、斜支或穿支细小等变异情况的一种替代方法。该手术具有操作简单、创伤小等优点，有效保障了手术的顺利进行。
- 穿支皮瓣 /
- 显微外科手术 /
- 股动脉 /
- 解剖变异 /
- 股内侧
Abstract: Objective To investigate clinical effects of anterolateral thigh flap with blood supply source of medial femoral perforator in repairing the wounds on extremities. Methods A retrospective observational study was conducted. From October 2018 to June 2021, Suzhou Ruihua Orthopedic Hospital admitted 12 patients (11 males and 1 female, aged 24-64 years) who met the inclusion criteria, and did not have the lateral circumflex femoral artery during anterolateral thigh flap resection, or changed to medial femoral perforator as a source of blood supply due to small perforator to repair the wound with flap transplantation. The wounds were on the upper limbs in 7 cases and on the lower limbs in 5 cases. The wound area after debridement was 8.0 cm×5.0 cm-24.0 cm×6.5 cm, and the applied flap area was 9 cm×6 cm-25 cm×7 cm. During transplantation, the perforating branch or source artery of the flap was anastomosed end to end with the vascular pedicle of the recipient area. Subcutaneous beauty suture was performed on all the donor wounds. After operation, the survival of the flap and vascular crisis were observed; and the wound healing at the donor site was observed. During follow-up, the texture of the flap and complications at the donor site were observed. At the last follow-up, the effect of flap repair was evaluated by using the modified self-made comprehensive efficacy rating table. Results After operation, all the flaps of patients survived without vascular crisis; the wounds in the donor site healed smoothly. During follow-up of 6 to 26 months, the flaps had good texture; only linear scars remained in the donor area without scar contracture, pain or other discomfort. At the last follow-up, the total score of flap repair effect of 12 patients was 75-95, with an average of 87, of which 5 cases were rated as excellent, 6 cases as good, and 1 case as fair, and the proportion of excellent and good patients was 11/12. Conclusions The application of anterolateral thigh flap with blood supply from the medial femoral perforator to repair wounds on extremities is an alternative method for the vascular variations such as no descending branch, oblique branch, or small perforator of the lateral circumflex femoral artery during the resection of the anterolateral thigh flap. This operation has the advantages of simple operation, small trauma, and others, which effectively ensures the smooth operation.
- Perforator flap /
- Microsurgery /
- Femoral artery /
- Anatomic variation /
- Medial thigh
杨成鹏：论文写作、资料收集；唐林峰、巨积辉：提出研究理念、手术操作、课题设计、经费支持；柳志锦、刘胜哲：完善研究理念、资料收集；杨林、程俊楠、张韬：资料收集以及手术操作；孙丰文、黄永涛、高钦锋：资料收集

所有作者均声明不存在利益冲突

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1 切开股前外侧区皮瓣时观察到的内侧穿支（黄色箭头所示）

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2 采用以股内侧穿支为血供来源的股前外侧区皮瓣修复例1患者的交通事故伤致左小腿创面的疗效。2A.术前左小腿远端创面清创后即刻；2B.于右大腿设计皮瓣；2C.显示皮瓣内侧来源的2条穿支情况，该2条穿支均较粗大；2D.皮瓣游离切取后即刻；2E、2F.分别为皮瓣移植术后22个月，受区和供区创面情况，受区皮瓣存活良好，供区创面仅遗留线性瘢痕

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3 采用以股内侧穿支为血供来源的股前外侧区皮瓣修复例2患者的压伤致右手创面的疗效。3A.术前右手掌皮肤坏死情况；3B.右手掌清创后即刻；3C.左大腿上的皮瓣设计；3D.皮瓣内侧穿支来源的情况，该穿支较粗大；3E、3F.分别皮瓣术后6个月随访时右手正面、侧面观，皮瓣外观稍显臃肿

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