股前外侧皮瓣游离移植修复四肢远端软组织缺损

Free transplantation of anterolateral femoral skin flap for repairing of soft tissue defects in distal part of extremities

目的探讨股前外侧皮瓣游离移植修复四肢远端软组织缺损的理想术式。方法1999年7月以来,选用股前外侧皮瓣游离移植修复四肢远端皮肤软组织缺损并获随访3个月以上的病人53例53块皮瓣。男47例,女6例;年龄13～59岁,软组织缺损面积最小为14cm×5cm,最大为25cm×14cm,皮瓣面积最小为16cm×7cm,最大为27cm×17cm。皮瓣携带股外侧皮神经并将其与受区皮神经吻合36例,未吻合皮神经17例。术后随访6￣50个月,对皮瓣的外形、血液循环和感觉进行观测研究。结果本组53例53块皮瓣,完全成活47例;4例边缘部分坏死,经换药和皮片移植而愈合;2例完全坏死,改用背阔肌皮瓣修复。吻合股外侧皮神经34例(另2例术后坏死不计算在内)中30例恢复保护性感觉,未吻合皮神经17例中2例恢复保护性感觉。吻合皮神经组与未吻合皮神经组比较,保护性感觉的恢复率差异有显著性(P<0.001)。术后随访,51例血液循环良好,2例足跟部皮瓣慢性溃疡。结论吻合股外侧皮神经的股前外侧皮瓣游离移植是修复四肢远端软组织缺损较为理想的术式。

【Objective】 To explore an ideal operative type of free transplantation of anterolateral femoral skin flap For repairing of soft tissue defects in the distal part of extremities. 【Methods】 53 eases with soft tissue defects in the distal part of extremities were treated by means of transplantation of free anterolateral femoral skin flaps since July 1999. The patients aged from 13 to 59 years oht, 47 male and 6 female. The area of soft tissue defects ranged from 14 cm×5 cm to 25 cm×14 cm, the flaps were 16 cm×7 cm to 27 cm×17 cm in size, Lateral femoral cutaneous nerve was sutured with a cutaneous nerve of receptive site in 36 cases. All the cases wore followed up postoperatively from 6 months to 50 months, The shape、circulatiou and the restoration of sensation of the flaps were observed and studied. 【Results】 47 flaps survived perfectly, 4 flaps survived with partial necrosis and healed alter changing dressings or skin graft, 2 flaps failed to survive and were replaced by free latissimus dorsi myoeutaneous flaps. Oat of 34 eases （excluding 2 eases with failure） 30 were satisfactory with restoration of protective sensation dire to the anastomosis of lateral femoral cutaneous nerve and a skin nerve of the receptive site, only 2 cases got the sinfilar results in 17 cases without cutaneous nerve anastomosis. The results were significantly different between two groups （P 〈 0.001）. 51 flaps were good in circulation, 2 flaps located under the tibet survived with local chronic necrosis. 【Conclusion】 Free transplantation of anterolateral femoral skin flap companied with the anastomosis of the lateral femoral cntaneous nerve and a skin nerve of receptor site is relatively an ideal operative type for the repair of soft tissue defects in the distal part of extremities.