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
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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。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.
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Key words:
- Wounds and injuries /
- Surgical procedures, operative /
- Fascia flaps /
- Skin grafting /
- Wound repair
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参考文献
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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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