股前外侧游离皮瓣修复足跟大面积软组织缺损

Microvascular anastomotic anterolateral thigh flaps for reconstruction of traumatic widespread defects of soft tissue in heel

目的探讨股前外侧游离皮瓣移植修复足跟大面积创伤性软组织缺损的临床效果。方法1997年10月至2005年3月,应用股前外侧游离皮瓣移植修复足跟大面积软组织缺损26例,将旋股外侧动脉降支及其伴行静脉分别与胫后动静脉吻合,并将股外侧皮神经与隐神经或腓肠神经吻合,使皮瓣具有感觉功能,并将阔筋膜缝合固定于跟骨以增加皮瓣稳定性。结果移植皮瓣全部成活,创面一期愈合,经3个月至4年的随访,皮瓣感觉部分恢复,足跟外形与稳定性良好。结论股前外侧游离皮瓣供区隐蔽,血供丰富,可切取范围大,特别是带有感觉神经和阔筋膜,修复足跟耐磨、稳定性好,是修复足跟大面积软组织缺损的理想皮瓣。

Objective To explore the results of repairing widespread defects of traumatic soft tissue in heel by microvascular anastomotic anterolateral thigh flaps. Methods Twenty-six consecutive free anterolateral thigh flaps in 26 patients were transplanted for repairing widespread defects of traumatic soft tissue in heel from October 1997 to March 2005, suturing the descending branch of the lateralcircumflex femoral vascular and posterior tibial vascular to reconstruct the blood supply of transplanted flaps, repairing lateral femoral cutaneous nerve to recover their sensation, fixing tensor fasciae in the calcaneum to add their stabilization. Results All flaps survived completely, the wounds healed in the initial treatment, follow up 3 to 48 months, twenty-six cases achieved partial sensation, good contour and stabilization. Conclusions The anterolateral thigh flap is an ideal flap for repairing widespread defects of traumatic soft tissue in heel, because it has such advantages as adequate blood supply , big dermatomic area and covert donor site , furthermore, nervi cutaneus femoris lateralis and tensor fasciae offer the good sensation and adequate stabilization.