股前外侧嵌合穿支皮瓣修复足踝部复杂创面的效果

计鹏; 曹涛; 张智; 郑朝; 梁敏; 田晨阳; 郝彤; 陈雷雷; 胡大海; 韩军涛; 陶克

doi:10.3760/cma.j.cn501225-20230627-00232

股前外侧嵌合穿支皮瓣修复足踝部复杂创面的效果

doi: 10.3760/cma.j.cn501225-20230627-00232

计鹏¹,
曹涛¹,
张智¹,
郑朝¹,
梁敏¹,
田晨阳¹,
郝彤¹,
陈雷雷²,
胡大海¹,
韩军涛¹,
陶克^3, ,

1.
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
2.
兴平市人民医院骨外科，兴平　　713100
3.
温州医科大学附属第一医院创面修复与再生医学中心创面修复科，温州　　325015

基金项目:

国家自然科学基金面上项目 82272269

详细信息

通讯作者:
陶克，Email：tao-ke2001@163.com

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出版历程
- 收稿日期: 2023-06-27

Effects of the anterolateral thigh chimeric perforator flaps in repairing complex wounds of foot and ankle

1.
Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
2.
Department of Orthopedics, Xingping People's Hospital, Xingping 713100, China
3.
Department of Wound Repair, Center for Wound Repair and Regenerative Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China

Funds:

General Program of National Natural Science Foundation of China 82272269

More Information

Corresponding author: Tao Ke, Email: tao-ke2001@163.com

摘要

摘要: 目的探讨应用股前外侧嵌合穿支皮瓣修复足踝部复杂创面的效果。方法采用回顾性观察性研究方法。2018年5月—2022年6月，空军军医大学第一附属医院收治23例符合入选标准的采用股前外侧嵌合穿支皮瓣修复足踝部复杂创面的患者，其中男15例、女8例，年龄20~66岁。创面均伴骨外露及缺损，且合并不同程度感染。所有患者均于Ⅰ期行清创+持续负压封闭引流治疗1周，清创后皮肤软组织缺损面积为10 cm×5 cm~22 cm×7 cm；Ⅱ期采用股前外侧嵌合穿支皮瓣覆盖缺损创面，采用其中的肌瓣填塞踝关节部位深部无效腔或覆盖骨、内固定外露处，采用其中的皮瓣覆盖浅表创面，切取皮瓣面积为11 cm×6 cm~23 cm×8 cm、肌瓣面积为4.0 cm×2.5 cm~8.0 cm×5.0 cm。术后观察皮瓣成活情况。随访时，观察皮瓣色泽、质地、外形及并发症情况，观测踝关节功能及其背伸活动度和跖屈活动度，观察供区瘢痕增生及肌疝发生情况。结果 1例患者皮瓣尖端皮肤术后5 d出现淤斑、表皮坏死，经换药1周后愈合；其余患者皮瓣均顺利成活。术后随访6~40个月，皮瓣色泽、质地、外形均良好，无并发症发生，但其中1例患者因皮瓣较臃肿对皮瓣外形不满意；踝关节活动基本正常，背伸活动度为15~30°，跖屈活动度为20~45°；皮瓣供区瘢痕增生不明显，无肌疝发生。结论股前外侧嵌合穿支皮瓣在有效填塞踝关节部位创面深部无效腔的同时可覆盖浅表创面，且供区损伤小，是修复足踝部复杂创面的较为理想的皮瓣。
- 显微外科手术 /
- 穿支皮瓣 /
- 旋股外侧动脉 /
- 嵌合皮瓣 /
- 足踝部 /
- 创面修复
Abstract: Objective To investigate the effects of anterolateral thigh chimeric perforator flap in repairing complex wounds of foot and ankle. Methods A retrospective observational study was conducted. From May 2018 to June 2022, 23 patients who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University to repair complex wounds of foot and ankle with anterolateral thigh chimeric perforator flaps, including 15 males and 8 females, aged from 20 to 66 years. The wounds were all accompanied by bone exposure and defects, and were complicated with varying degrees of infection. All patients underwent debridement and continuous vacuum sealing drainage treatment for 1 week in stage Ⅰ, with the skin and soft tissue defect area after debridement being 10 cm×5 cm to 22 cm×7 cm. In stage Ⅱ, the anterolateral thigh chimeric perforator flap was used to cover the defective wound, of which the muscle flap was used to fill the deep invalid cavity of the ankle joint or cover bone and internal fixation exposures, and the skin flap was used to cover the superficial wound, with the area of the skin flap ranging from 11 cm×6 cm to 23 cm×8 cm, and the area of the muscle flap ranging from 4.0 cm×2.5 cm to 8.0 cm×5.0 cm. The survival of the flap was observed after operation. During follow-up, the color, texture, appearance, and complications of the flap were observed, the function of ankle joint and its range of dorsiflexion motion and plantar flexion motion were measured, and the scar hyperplasia and muscular hernia in donor area were observed. Results Ecchymosis and epidermal necrosis occurred at the tip of the flap in 1 patient on 5 days after operation and healed after dressing change for 1 week; the other flaps of patients survived successfully. After 6 to 40 months of follow-up, the color, texture, and shape of flaps were good, but 1 patient was not satisfied with the shape of the flap because of flap swelling; the ankle joint movement was basically normal, the dorsiflexion motion was 15-30°, and the plantar flexion motion was 20-45°; the scar hyperplasia in the donor area of the flap was not obvious, and no muscular hernia occurred. Conclusions The anterolateral thigh chimeric perforator flap can effectively fill the deep invalid cavity of ankle joint and cover the superficial wound at the same time, with minimal damage to the donor site. So it is an ideal flap for repairing the complex wounds of foot and ankle.
- Microsurgery /
- Perforator flap /
- Lateral femoral circumflex artery /
- Chimeric flap /
- Foot and ankle region /
- Wound repair
计鹏：手术设计和实施、论文写作；曹涛：采集及分析数据；张智、田晨阳：资料收集以及手术操作；郑朝、胡大海、韩军涛：完善研究理念；梁敏、郝彤、陈雷雷：资料收集；陶克：提出研究理念、设计课题、经费支持

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参考文献(26)

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1 右股前外侧嵌合穿支皮瓣修复例1患者交通伤致右足踝部创面。1A.术前患者右足内踝的创面情况，内踝处皮肤坏死、感染，跟骨部分外露；1B.清创后创面情况，可见部分踝关节韧带及跟骨坏死，克氏针外露；1C.清创后行持续负压封闭引流1周后，创基清洁、血运改善；1D.设计股前外侧嵌合穿支皮瓣；1E.游离切取皮瓣后即刻正面观；1F.将嵌合穿支皮瓣转移至受区创面并缝合后即刻；1G.右大腿供区创面直接拉拢缝合后即刻；1H.术后14个月随访时，受区皮瓣色泽、质地、外形均良好

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2 左股前外侧嵌合穿支皮瓣移植修复例2患者碾压伤致左足踝部创面。 2A.术前左足内踝创面情况，创面坏死组织及渗出较多，胫骨部分外露且伴缺损；2B.清创术中创面情况，可见内踝上胫骨外露且伴部分骨缺损；2C.设计股前外侧嵌合穿支皮瓣；2D、2E.分别为游离切取皮瓣后背面观、正面观；2F.左大腿供瓣区阔筋膜关闭即刻；2G.股前外侧嵌合穿支皮瓣转移至受区后，用其中的肌瓣填塞骨缺损和无效腔，穿支皮瓣覆盖创面；2H.左大腿皮瓣供区缝合后即刻；2I.股前外侧嵌合穿支皮瓣缝合后即刻；2J、2K.分别为术后40个月随访时，内踝侧面观、正面观；2L.术后40个月随访时，供区仅遗留线状瘢痕

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