旋股外侧动脉嵌合穿支皮瓣修复足踝部复合组织缺损的效果

李海; 邓呈亮; 肖顺娥; 吴祥奎; 吴必华; 魏在荣

doi:10.3760/cma.j.cn501225-20240202-00045

旋股外侧动脉嵌合穿支皮瓣修复足踝部复合组织缺损的效果

doi: 10.3760/cma.j.cn501225-20240202-00045

遵义医科大学附属医院烧伤整形外科,遵义　　563000

基金项目:

省部共建协同创新中心项目 2020-39

详细信息

通讯作者:
邓呈亮,Email：cheliadeng@sina.com

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出版历程
- 收稿日期: 2024-02-02

Effects of the lateral circumflex femoral artery chimeric perforator flap in repairing composite tissue defects in the ankle and foot area

Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China

Funds:

Collaborative Innovation Center of Chinese Ministry of Education 2020-39

More Information

Corresponding author: Deng Chengliang, Email: cheliadeng@sina.com

摘要

摘要: 目的探讨采用旋股外侧动脉嵌合穿支皮瓣修复足踝部的复合组织缺损的效果。方法该研究为回顾性观察性研究。2018年1月—2023年12月,遵义医科大学附属医院烧伤整形外科收治12例符合入选标准的足踝部复合组织缺损患者,其中男9例、女3例,年龄4~64岁,致伤原因为交通事故伤者7例、绞伤者2例、压砸伤者2例、摔伤者1例。患者均合并皮肤软组织缺损（缺损面积为10.0 cm×5.0 cm~22.0 cm×7.0 cm）,其中7例患者合并3 cm×2 cm~6 cm×5 cm大小的踝关节囊缺损,3例患者合并4~8 cm长的跟腱缺损,1例患者合并4 cm长的𧿹长伸趾肌腱缺损,1例患者合并10 cm长的趾长伸趾肌腱缺损。所有患者均采用旋股外侧动脉嵌合穿支皮瓣进行复合组织缺损修复,其中11.0 cm×5.5 cm~24.0 cm×6.5 cm大小皮瓣用于修复皮肤软组织缺损,4.0 cm×2.5 cm~17.0 cm×2.0 cm大小阔筋膜瓣用于修复关节囊、肌腱缺损。将供瓣区创面拉拢缝合。术后定期随访,观察术后皮瓣成活情况、缺损修复情况、供瓣区切口愈合情况、并发症发生情况、皮瓣外观与质地、术区瘢痕形成情况、供瓣侧下肢活动情况。末次随访时,采用美国矫形足踝协会评分标准评定足踝部功能。结果患者均获随访,随访时间2~38个月,平均8.7个月。术后皮瓣全部成活,受区创面均愈合,踝关节囊与肌腱重建者关节无肿胀,关节活动较好,无垂足、垂趾畸形。供瓣区切口均愈合,均无并发症发生。2例患儿家属因自觉皮瓣臃肿分别于术后3、4个月带其患儿返院行皮瓣修薄术,其余患者对皮瓣外观、质地表示满意。1例患儿早期瘢痕增生明显,经外涂抗瘢痕药物及压力治疗后瘢痕逐渐淡化,其余患者瘢痕不明显。所有患者供瓣侧下肢活动正常。末次随访时,足踝部功能评定为优者8例、良者4例。结论旋股外侧动脉嵌合穿支皮瓣设计灵活,可同时修复足踝部皮肤软组织、关节囊及肌腱等复合组织缺损,供瓣区无明显并发症,大多数患者对受区皮瓣外观表示满意,皮瓣质地柔软,足踝部功能恢复较佳。
- 创伤和损伤 /
- 足 /
- 显微外科手术 /
- 外科皮瓣 /
- 软组织缺损 /
- 嵌合穿支皮瓣 /
- 创面修复
Abstract: Objective To investigate the effects of applying the lateral circumflex femoral artery chimeric perforator flap in repairing composite tissue defects in the ankle and foot area. Methods This study was a retrospective observational study. From January 2018 to December 2023, 12 patients with composite tissue defects in the ankle and foot area who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University, including 9 males and 3 females, aged from 4 to 64 years. The causes of the injuries included traffic accident injuries in 7 cases, wringing injuries in 2 cases, crush injuries in 2 cases, and fall injury in 1 case. All patients had combined skin and soft tissue defects, with the defect areas ranging from 10.0 cm×5.0 cm to 22.0 cm×7.0 cm. Among them, 7 patients had ankle joint capsule defects sized from 3 cm×2 cm to 6 cm×5 cm; 3 patients had Achilles tendon defects ranged from 4 to 8 cm in length; 1 patient had an extensor hallucis longus tendon defect of 4 cm in length; 1 patient had an extensor digitorum longus tendon defect of 10 cm in length. All patients underwent repair of the composite tissue defects using the lateral circumflex femoral artery chimeric perforator flaps. Flaps with sizes ranging from 11.0 cm×5.5 cm to 24.0 cm×6.5 cm were used to repair skin and soft tissue defects, and fascia lata flaps with sizes ranging from 4.0 cm×2.5 cm to 17.0 cm×2.0 cm were used to repair joint capsule and tendon defects. The flap donor area wound was closed by suturing. Postoperatively, regular follow-up was conducted to observe the survival of the flaps after surgery, the repair of the defects, the healing of the incisions in the flap donor area, the occurrence of complications, the appearance and texture of the flaps, the scar formation in the surgical area, and the movement of the lower limb on the flap donor side. At the last follow-up, the American Orthopaedic Foot and Ankle Society scoring standard was used to evaluate the function of the ankle and foot. Results All patients were followed up for 2 to 38 months, with an average of 8.7 months. After surgery, all flaps survived, and all wounds in the recipient areas healed. In patients who underwent ankle joint capsule and tendon reconstruction, there was no swelling in the joints, and the joint movements were good without foot drop or toe drop deformities. All incisions in the flap donor areas were healed without any complication. The families of 2 children took their children back to the hospital for flap thinning at 3 and 4 months respectively after surgery because they felt that the flaps were bulky. The other patients were satisfied with the appearance and texture of the flaps. One child had obvious scar hyperplasia in the early stage, and the scar gradually faded after external application of anti-scar medications and pressure treatment. The scars of the other patients were not obvious. All patients had normal lower limb movements on the flap donor side. At the last follow-up, the functions of the ankle and foot were rated as excellent in 8 cases and good in 4 cases. Conclusions The lateral circumflex femoral artery chimeric perforator flap is flexible in design. It can repair the composite tissue defects in the skin and soft tissue, joint capsules, and tendons of the ankle and foot simultaneously. There are no obvious complications in the flap donor area. Most patients are satisfied with the appearance of the flap in the recipient area. The flap is soft in texture, and the functions of the ankle and foot are well restored.
- Wounds and injuries /
- Foot /
- Microsurgery /
- Surgical flaps /
- Soft tissue defect /
- Chimeric perforator flap /
- Wound repair
李海：开展手术、实施研究、论文选题和设计、起草论文、修改并完善论文,分析数据及疗效；邓呈亮：参与研究,并对文章的知识性内容作批判性审阅；肖顺娥、吴祥奎、吴必华：协助参与手术、修改论文；魏在荣：研究指导

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图 1 游离移植左侧旋股外侧动脉分叶嵌合穿支皮瓣修复例1患者右踝关节复合组织缺损的效果。1A.术中清创后见右踝关节皮肤软组织、右踝关节囊复合缺损；1B.左侧旋股外侧动脉分叶嵌合穿支皮瓣穿支探查及设计；1C.术中嵌合阔筋膜瓣的分叶嵌合穿支皮瓣切取；1D.术中将携带阔筋膜瓣的远端蒂皮瓣分叶覆盖到创面上,其中阔筋膜瓣覆盖关节囊缺损；1E.皮瓣修复踝部创面术后即刻；1F.术后4个月皮瓣修薄术中见阔筋膜瓣重建关节囊完整；1G、1H.分别为Ⅱ期术后14个月受区皮瓣、供瓣区外观,均较佳

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图 2 游离移植右侧旋股外侧动脉嵌合穿支皮瓣修复例2患者左足背复合足趾缺损的效果。2A.术前左足皮肤软组织、第2~4趾长伸趾肌腱缺损；2B.术前穿支探查及旋股外侧动脉嵌合穿支皮瓣设计；2C.术中分离穿支并探查保护阔筋膜供血穿支；2D.术中游离皮瓣；2E.皮瓣修复足部创面术后即刻；2F.术后4个月,足部外观较佳

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