分叶股前外侧肌皮瓣修复前臂组织缺损与功能重建

Ramified anterolateral thigh myocutaneons flap transfer for upper extremity tissue defect repair and functional reconstruction

目的设计分叶股前外侧肌皮瓣并初步临床用于修复前臂组织缺损与功能重建。方法对2例前臂外伤后屈、伸肌群缺损的患者，设计分叶股前外侧肌皮瓣覆盖前臂皮肤和肌肉缺损，重建运动功能。结果术后2例皮瓣全部存活，伤口Ⅰ期愈合，随访时间1例为6个月，1例为14个月。肌电图募集反应为单纯相和混合相，静息电位为正向电位和纤颤电位；1—5指指屈肌力恢复至2级1例，但不能抓握，不能对指；恢复至4级1例，可部分伸直掌指关节。结论股前外侧肌的血管神经蒂长、恒定、粗大，可以制成分叶肌皮瓣，是覆盖肢体创面重建运动功能的良好选择。

Objective To design ramified anterolateral thigh myocutaneous flap and evaluate its application in upper extremity tissue defect repair and fimctional reconstruction. Methods Two patients with upper extremity injuries that caused loss of skin coverage and forearm flexors and extensors were treated. Ramified anterolateral thigh myocutaneous flap was designed and transferred to cover the skin defect and reconstruct motor function. Results Both flaps survived in the 2 cases and wound healing was uneventful. Follow-up period was 6 month for 1 case and 14 months for the other. Recruitment response in electromyograph showed simple phase and combined phase respectively. Resting potential showed positive wave and fibrillation potential. Muscle power of finger flexors reached MRC 2 in 1 case. No grasp and opposition was restored yet. In the other case, muscle power of finger flexors was MRCA. The patient could extend the metacarpephalangeal joints to some extent. Conclusion Anterolateral thigh myocutaneous flap has a long, big and constant neurovaacular pedicle. It can be configured to a ramified myocutaneous flap and transferred to cover soft tissue defect of the extremities and restore motor function at the same time.