游离颞浅筋膜瓣/股前外侧筋膜瓣联合皮片移植修复四肢特殊部位深度组织缺损的临床经验

杨薛康; 张栋梁; 何亭; 张月; 徐志刚; 魏婧韬; 李军; 刘梦栋

doi:10.3760/cma.j.cn501225-20220915-00407

游离颞浅筋膜瓣/股前外侧筋膜瓣联合皮片移植修复四肢特殊部位深度组织缺损的临床经验

doi: 10.3760/cma.j.cn501225-20220915-00407

空军军医大学第一附属医院全军烧伤中心，烧伤与皮肤外科，西安　　710032

基金项目:

国家自然科学基金青年科学基金项目 81701902

陕西省重点研发计划一般项目 2023-YBSF-427

详细信息

通讯作者:
刘梦栋，Email：liumd_fmmu@126.com

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出版历程
- 收稿日期: 2022-09-15

Clinical experience of free superficial temporal fascia flap/anterolateral femoral fascial flap combined with skin grafting in repairing deep tissue defects of special parts of extremities

Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China

Funds:

Youth Science Foundation Program of National Natural Science Foundation of China 81701902

General Program of Key Research and Development Plan of Shaanxi Province of China 2023-YBSF-427

More Information

Corresponding author: Liu Mengdong, Email: liumd_fmmu@126.com

摘要

摘要: 四肢的深度组织缺损易造成肌腱、血管、神经及骨质外露，临床常采用游离皮瓣修复。但对于手指、足趾、踝后、胫前、足背等特殊部位，采用游离皮瓣修复后外观通常会显得臃肿，后期需行多次去脂手术，给患者造成沉重的生理、心理及经济负担。筋膜瓣柔软、纤薄，且具有血运好、抗感染能力强等优点，利用游离筋膜瓣移植联合皮片移植在此类创面的修复中具有一定优势，但由于手术难度大，术后血运不易观察等不足严重限制了其临床应用。近年来笔者团队在游离颞浅筋膜瓣/股前外侧筋膜瓣联合皮片移植修复四肢特殊部位深度组织缺损方面开展了大量工作，积累了丰富的经验。该文主要从临床角度介绍游离颞浅筋膜瓣/股前外侧筋膜瓣的解剖和切取方法及临床应用的优点、难点和注意事项，供同行参考。
- 创伤和损伤 /
- 外科手术 /
- 筋膜瓣 /
- 皮片移植 /
- 创面修复
Abstract: The deep tissue defects of extremities are prone to cause the exposure of tendons, blood vessels, nerves, and bones, which are commonly repaired with free flaps in clinical practice. However, for special parts such as fingers, toes, posterior ankles, anterior tibias, and dorsum of feet, the appearances are usually bulky after being repaired with free flaps and need lipectomy operations, which bring great physiological, psychological, and economic burden to patients. As the fascia flap is soft and thin with reliable blood supply and strong anti-infection ability, the free fascia flap combined with skin grafting offers some advantages in repairing the above-mentioned wounds. However, its clinical application is severely limited due to the complexity of surgical operation and the difficulty in observing blood supply after operation. In recent years, our team has carried out a lot of work and accumulated rich experience in repairing deep tissue defects of special parts of extremities with free superficial temporal fascia flap/anterolateral femoral fascial flap combined with skin grafting. From the clinical perspective, this paper mainly introduces the anatomy and harvesting method of free superficial temporal fascia flap/anterolateral femoral fascial flap, as well as the advantages, difficulties, and precautions of clinical application, for reference of peers.
- Wounds and injuries /
- Surgical procedures, operative /
- Fascia flaps /
- Skin grafting /
- Wound repair
所有作者均声明不存在利益冲突

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1 股前外侧筋膜瓣联合头部刃厚皮片移植修复患者左足背皮肤坏死创面。1A.足背创面清创术前可见发黑坏死皮肤；1B.行持续负压封闭引流治疗1周后拆除负压材料行创面修复手术，术中可见肌腱外露；1C.筋膜瓣浅面携带部分脂肪组织；1D.筋膜瓣深面携带部分阔筋膜；1E.右侧大腿筋膜瓣供区缝合后即刻；1F.筋膜瓣深面的阔筋膜覆盖外露肌腱后即刻；1G.筋膜瓣浅面移植刃厚皮片后即刻；1H.术后7 d，筋膜瓣及皮片存活良好，足背外观不臃肿

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2 股前外侧筋膜瓣联合头部刃厚皮片移植修复患者右侧胫前溃疡伴胫骨外露创面。2A.清创术前可见胫骨外露伴骨髓炎；2B.行持续负压封闭引流治疗1周后拆除负压材料行创面修复手术，术中可见部分胫骨及骨髓腔外露；2C.筋膜瓣浅面携带部分脂肪组织；2D.筋膜瓣深面携带部分肌肉组织；2E.筋膜瓣深面肌肉组织覆盖胫骨并填塞骨髓腔后即刻；2F.筋膜瓣血管端侧吻合至胫后动静脉及大隐静脉；2G.筋膜瓣浅面移植刃厚皮片后即刻；2H.术后1个月随访，创面恢复良好，外形平整、不臃肿

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参考文献(21)

[1]	姚群,芮永军,糜菁熠,等.吻合血管的前臂中段尺动脉穿支皮瓣修复手指皮肤软组织缺损[J].中华手外科杂志,2018,34(2):124-125.DOI: 10.3760/cma.j.issn.1005-054X.2018.02.017.
[2]	张敬良,雷彦文,宋君,等.手部组织缺损修复方法的个性化路径式选择[J].中华显微外科杂志,2013,36(4):343-347.DOI: 10.3760/cma.j.issn.1001-2036.2013.06.008.
[3]	YangX,FangZ,LiuM,et al.Free vascularized anterolateral thigh fascia lata flap for reconstruction in electrical burns of the severely damaged finger[J].J Burn Care Res,2019,40(2):242-245.DOI: 10.1093/jbcr/irz010.
[4]	LiuM,YangY,ZhangY,et al.Surgical reconstruction of complex distal foot defects with vascularized fascia lata[J].Ann Plast Surg,2020,84(5):525-528.DOI: 10.1097/SAP.0000000000002115.
[5]	YangX,FangZ,LiuM,et al.Reconstruction of deep burn wounds around the ankle with free fascia flaps transfer and split-thickness skin graft[J].J Burn Care Res,2019,40(6):763-768.DOI: 10.1093/jbcr/irz078.
[6]	YangX,ZhaoH,LiuM,et al.Repair of deep tissue defects in the posterior talocrural region using a superficial temporal fascia free flap plus thin split-skin grafting in extensively burned patients: a retrospective case series[J].Medicine (Baltimore),2018,97(3):e9250.DOI: 10.1097/MD.0000000000009250.
[7]	YangX,FangZ,LiuM,et al.Free vascularized fascia flap combined with skin grafting for deep toe ulcer in diabetic patients[J].J Surg Res,2018,231:167-172.DOI: 10.1016/j.jss.2018.05.051.
[8]	SteccoC, MacchiV, PorzionatoA, et al. The fascia: the forgotten structure[J]. Ital J Anat Embryol, 2011,116(3):127-138.
[9]	王炎之.筋膜瓣的临床应用[J].广东解剖学通报,1989(2):180-183.
[10]	SteccoC,TiengoC,SteccoA,et al.Fascia redefined: anatomical features and technical relevance in fascial flap surgery[J].Surg Radiol Anat,2013,35(5):369-376.DOI: 10.1007/s00276-012-1058-0.
[11]	DavidgeKM,van FurthWR,AgurA,et al.Naming the soft tissue layers of the temporoparietal region: unifying anatomic terminology across surgical disciplines[J].Neurosurgery,2010,67(3 Suppl Operative):ons120-129; discussion ons129-130.DOI: 10.1227/01.NEU.0000383132.34056.61.
[12]	于晓波,蒋海越,潘博,等.颞顶筋膜瓣在修复外耳再造术后支架外露的应用[J].中国美容医学,2011,20(1):36-38.DOI: 10.3969/j.issn.1008-6455.2011.01.017.
[13]	杨巧.颞顶筋膜瓣的解剖基础与临床应用进展[J].中国美容医学,2012,21(16):42-44.DOI: 10.3969/j.issn.1008-6455.2012.16.034.
[14]	郭佩佩,蒋海越.颞浅筋膜瓣在整形修复外科领域的临床应用进展[J].中华整形外科杂志,2019,35(12):1271-1274.DOI: 10.3760/cma.j.issn.1009-4598.2019.12.022.
[15]	芮永军.股前外侧皮瓣在中国的研究进展[J].中华显微外科杂志,2020,43(4):313-325.DOI: 10.3760/cma.j.cn441206-20200628-00277.
[16]	张启旭,乔群,陈光宇,等.股前外侧脂肪筋膜瓣血管三维结构的研究及应用[J].中华整形外科杂志,2002,18(4):200-203.DOI: 10.3760/j.issn:1009-4598.2002.04.002.
[17]	张功林,葛宝丰,王世勇,等.应用吻合血管的阔筋膜瓣联合游离皮片移植修复手指软组织缺损的经验介绍[J].中华手外科杂志,1999,15(2):99-100.DOI: 10.3760/cma.j.issn.1005-054X.1999.02.120.
[18]	张治家,刘洁,郭芳芳,等.股前外侧皮瓣带血管化的阔筋膜在跟腱及软组织缺损中的应用[J/CD].中华临床医师杂志:电子版,2019,13(12):918-921.DOI: 10.3877/cma.j.issn.1674-0785.2019.12.009.
[19]	俞俊兴,缪洪华,秦军.游离股前外侧筋膜瓣改良植皮修复手足皮肤软组织缺损[J].实用手外科杂志,2006,20(1):51-52,封三.DOI: 10.3969/j.issn.1671-2722.2006.01.028.
[20]	张娟子,刁其先,李林,等.游离股前外侧筋膜瓣和皮瓣治疗手足软组织创伤疗效对比[J].中外医疗,2015,34(28):14-15.DOI: 10.3969/j.issn.1674-0742.2015.28.006.
[21]	张文正,伍辉国,章烽火,等.吻合血管股前外侧筋膜瓣的临床应用[J].中国修复重建外科杂志,2007,21(4):349-351.