不同肌皮支为蒂的股前外侧分叶皮瓣在四肢组织缺损中的应用

Ramified anterolateral femoral flaps pedicled with different musculocutaneous branches for soft-tissue defects at extremities

目的探讨以不同肌皮支为蒂的股前外侧分叶皮瓣在四肢组织缺损修复中的临床应用价值。方法2008年1月至2009年4月，针对80例股前外侧皮瓣移植患者手术中解剖学观察，依据不同患者血管肌皮支的特点，设计以不同平面旋股外侧动脉肌皮支为蒂的不同形状股前外侧分叶皮瓣，用于修复四肢2个以上独立创面的组织缺损，临床应用15例，其中男10例，女5例。组织缺损部位：手部4例，足部6例，小腿及足踝部5例。两处组织缺损区最大相距8cm，单一创面缺损范围3．0cm×3．5cm～8．0cm×11．5cm，单个皮瓣切取面积为5．0cm×5．0cm～9．0cm×15．0cm。结果手术中解剖学观察显示：肌皮支出现率为100％，总能找到位于不同平面的两个独立肌皮支。组织瓣源血管均为旋股外侧动脉降支。肌皮支穿出点分布在股前外侧肌前侧半及其与股直肌的肌间隙内，沿髂前上棘与髌骨外上缘连线的轴线2～4cm范围内；将轴线远1／2部分分成3段，粗大肌皮支在第一段的出现率为81％，第二段为67％，第三段为89％。术后15例患者皮瓣全部成活，无血管危象发生。术后获3—8个月随访，皮瓣质地柔软。6例因皮瓣臃肿于术后3周～3个月做皮瓣修薄术，外形满意。结论以不同肌皮支为蒂的股前外侧分叶皮瓣是修复四肢复杂组织缺损的一种有效方法。

Objective To introduce ramified anterolateral femoral flaps pedicled with different musculoeutaneous branches used for primary repair of soft-tissue defects at different regions of extremities. Methods From January 2008 to April 2009, 15 patients, 10 males and 5 females, were treated with anterolateral thigh flaps for their soft-tissue defects at limbs which involved 4 hands, 6 feet and 5 legs and ankles. Different shapes of anterolateral thigh flap were designed according to clinical anatomy and particular conditions of blood vessels and museulocutaneous branches in different cases. The flaps were ramified into 2 independent free flaps to repair 2 independent defects. The maximum distance between 2 defects was 8 cm. The area of defect ranged from 3.0 cm × 3.5 cm to 8.0 cm × 11.5 cm, and the flap area from 5.0 cm × 5.0 cm to 9. 0 cm × 15.0 cm. Results According to clinical anatomy, the presence of sareo-cutaneous branches was 100%. The source blood vessel of the flaps was quadrieeps artery of femur. The 15 patients were followed up from 3 to 8 months. The tissue grafts all survived and the flaps primarily healed at the recipient site. Revisions were done 3 weeks to 3 months after the primary operation to thin down the clumsy skin flaps in 6 cases. The shape and texture of the flaps were satisfactory. Conclusion Ramified anterolateral femoral flaps pedicled with different musculoeutaneous branches provide an ideal way of repairing severe and complex soft-tissue defects at extremities.