股前外侧穿支皮瓣修复四肢软组织缺损

REPAIR OF SOFT TISSUE DEFECT IN EXTREMITIES WITH ANTEROLATERAL THIGH PERFORATOR FLAP

目的总结游离或带蒂的股前外侧穿支皮瓣修复四肢软组织缺损的临床疗效。方法2000年3月-2009年1月,收治外伤致四肢软组织缺损32例。男30例,女2例;年龄4～53岁,中位年龄28岁。其中左手桡侧半3例,左肘外侧1例,膝周5例,小腿14例,足背5例,足底4例。软组织缺损范围9cm×6cm～15cm×13cm。伴骨缺损9例,桡神经干缺损1例。受伤至入院时间1h～4个月,平均5d。采用股前外侧穿支皮瓣游离移植27例,其中组合第2足趾移植1例、小隐静脉动脉化腓肠神经1例、腓骨瓣或髂骨瓣4例;带膝上外侧动脉血管蒂移位5例。吻合股外侧皮神经14例。皮瓣切取范围10cm×8cm～16cm×15cm。供区直接缝合或中厚皮片修复。结果29例术后皮瓣均成活,创面Ⅰ期愈合;3例术后出现皮瓣坏死,对症处理后痊愈。供区植皮全部成活,切口Ⅰ期愈合。32例均获随访,随访时间8个月～9年,平均1年6个月。皮瓣颜色、质地和厚薄与受区相近,术后6个月14例吻合股外侧皮神经皮瓣感觉恢复至S3～4,其余皮瓣恢复保护性感觉。移植骨瓣均于术后4～6个月达骨性愈合。供区无明显功能障碍。结论股前外侧穿支皮瓣血管蒂粗长,解剖恒定,便于移位或吻合,切取面积大,可通过吻合神经恢复皮瓣感觉,切取简便,对供区影响小,是修复四肢软组织缺损的一种有效方法。

Objective To summarize the clinical effect of anterolateral thigh pedicle or free perforator flap in repairing soft tissue defect in the extremities.Methods From March 2000 to January 2009,32 cases of soft tissue defect were treated with pedicle or free anterolateral thigh perforator flap.There were 30 males and 2 females with an median age of 28 years（4-53 years）.Soft tissue defects included left radial side in 3 cases,the left lateral elbow in 1 case,knee in 5 cases,calf in 14 cases,dorsalis pedis in 5 cases,and planta pedis in 4 cases.The defect area ranged from 9 cm×6 cm to 15 cm×13 cm.Nine cases complicated by bone defect and 1 case by radial nerve defect.The time from injury to hospitalization was 1 hour to 4 months（mean 5 days）.Defects in 27 cases were repaired by anterolateral thigh perforator flap,simultaneously combined with transplantation with the second toe in 1 case,with sural nerve using arterialized small saphenous vein in 1 case,and with fibular or ilium in 4 cases.Defects in other 5 cases were repaired with flaps pedicled with superior lateral genicular artery.Neuroanastomosis was performed in 14 cases of the flaps.The size of the flaps ranged from 10 cm×8 cm to 16 cm×15 cm.Skin defects at donor site were repaired with split thickness skin graft or sutured directly.Results All patients were followed up from 8 months to 9 years with an average of 18 months.The flaps survived well and the wounds healed by first intention in 29 cases,3 flaps necrosed and cured after symptomatic management.Skin graft at donor site survived completely in 9 cases.The color and texture and thickness of the flaps were similar to those of recipient site.After 6 months,the sensation of the flaps recovered to grade S3-4 in 14 patients whose cutaneous nerve were anastomosed,partial recovery was observed in other patients.In 4 patients receiving transplantation of fibular or ilium,the bony healing was achieved within 4 to 6 months.No obvious dysfunction was found at the donor site.Conclusion The pedicle anterolateral thigh perforator flap is long and thick with constant location.Anastomosis or transferring is easy to perform.It can provide big area and feeling recovery by nerve anastomosis.It is an effective method to repair soft tissue defect of the extremities.