旋股外侧动脉降支分叶肌皮瓣治疗肢体皮肤软组织缺损

Treatment of extremity infections with soft tissue defects with the ramified musculocutaneous flap pedicled with the descending branch of lateral circumflex femoral artery

目的探讨旋股外侧动脉降支为蒂的分叶肌皮瓣治疗肢体皮肤软组织缺损骨感染的临床效果。方法应用旋股外侧动脉降支为蒂,肌皮支形成股前外侧皮瓣、肌支形成股外侧肌瓣的分叶肌皮瓣游离移植,治疗四肢伴有骨关节感染、内固定外露的皮肤软组织缺损24例。结果术后23例肌皮瓣全部成活,1例坏死,行皮片移植术。Ⅰ期愈合16例,Ⅱ期愈合8例。3例于伤口愈合后形成窦道,其中1例两次形成窦道,均行清创手术后窦道闭合,最长1年后伤口愈合。4例外伤后骨髓炎伴骨缺损,于伤口愈合后6～8个月行植骨术,伤口无感染,其中2例骨愈合。22例伤口愈合后随访6～20个月无再感染。结论旋股外侧动脉降支分叶肌皮瓣具有血管蒂长、腔隙填充完全、应用灵活、抗感染力强的特点,是治疗伴有骨感染的肢体皮肤软组织缺损较为理想的肌皮瓣。

Objective To discuss the clinical effect of the ramified musculocutaneous flap pedicled with the descending branch of lateral circumflex femoral artery treatment of bones and arthrsis of extremity infections with soft tissue defects. Methods The muscle flap blooded with the muscular branch of lateral femoral muscle and musculocutaneous flap blooded with the musculocutaneous branch were designed, all of which were pedicled with the descending branch of lateral circumflex femoral artery. In clinic, 24 cases of bones and artbrosis of extremity infections with soft tissue defects were treated with this kind of ramified musculocutaneous flap. Results Of the 24 cases, 23 cases were survived while 1 case was lost. 16 cases were healed at stage Ⅰ , 8 cases were healed at stage Ⅱ. Sinus has formated in 3 cases, one of which twice, but they were healed in one year with the treatment of debridments. Four cases with osteomyelitis and bone defect were treated with bone grafting in the later 6 - 8 months after the wound has healed. Twenty-two cases were followed-up for 6 20 months, infection didn＇ t recur. Conclusion This kind of ramified musculocutaneous flap has such advantages as longer blood vessel pedicle, filling the defects completely flexible application and stronger anti-infection, that it may be an effective way in treating bones and arthrosises of extremity infections with soft tissue defects.