游离修薄股前外侧穿支皮瓣的临床应用

Clinical application of free super-thin anterolateral femoral perforator flap

目的探讨应用游离修薄股前外侧穿支皮瓣修复前臂、手、足部创面的临床疗效。方法先确定皮瓣穿支血管部位，以此为中心，设计皮瓣并切取，保留阔筋膜盘约4．0cm×3．0cm～3．0cm×2．5cm；“沙丘样”削除阔筋膜、皮下脂肪，皮瓣四周可将皮下脂肪完全削去，仅保留真皮层。采用游离修薄股前外侧穿支皮瓣修复前臂、手、足部创伤性软组织缺损15例。结果全部病例术后无血管危象发生，有1例修复前臂创面皮瓣远端约2．0cm×1．2cm浅表坏死，经换药愈合。15例术后经3个月～2年随访，皮瓣外形、质地良好，两点辨别觉为8．0～10．0mm。结论游离修薄股前外侧穿支皮瓣外形、质地优良．受区感觉恢复良好．对供区创伤小．不需二期整形．是修复手、足部创面优良供区．

Objective To explore clinical effect of repairing soft tissue defect in forearm, hand and foot with free super-thin anterelateral thigh perforator flaps. Methods At first the site of perforator vessels were determined by Doppler, then the flaps were designed and harvested with the site as center; the fascia lata and subcutaneous fat were removed by sandhill-likely only the 4.0 cm × 3.0 cm - 3.0 cm × 2.5 cm disclike fascia lata and dermis layer were reserved. 15 traumatic soft tissue defects including forearm, hand and foot were repaired with the ree super-thin anterolateral thigh perforator flaps. Results No vascular crisis happened and all skin grafts survived in donor sites. 2.0 cm × 1.2 cm of the distal of flap was necrosis in 1 case and it was healed by dress changing. 15 cases were followed up 3 months-2 years and the average is 6 months. The contour and texture of all flaps were good and two point discrimination （2-PD） was about 8-10 mm of. Conclusions The contour and texture of free super-thin anterolateral thigh perforator flap are good, the feeling of recipient site recovered well, it＇ s less injury for donor site and there is no reshaping for flap. It is a fineness donor site for repairing soft tissue defects in hand and foot.