股前外侧穿支皮瓣桥接旋髂浅动脉蒂组织瓣组合移植修复四肢骨与软组织缺损

Anterolateral thigh perforator flap bridging superficial circumflex iliac artery flap for the treatment of complex limb wound

目的探讨股前外侧穿支皮瓣桥接旋髂浅动脉蒂组织瓣组合移植修复四肢骨与软组织缺损的应用特点。方法回顾性分析2009年3月至2011年1月，用股前外侧穿支皮瓣制备血流桥接皮瓣串联旋髂浅动脉为蒂的髂骨骨皮瓣、髂骨膜骨瓣或皮瓣修复10例四肢骨与软组织缺损患者资料，男9例，女1例；年龄21-57岁，平均39．7岁；血流桥接髂骨骨皮瓣7例，髂骨膜骨瓣2例，髂腹股沟皮瓣1例；重建手3例，足4例，小腿3例；平均皮肤缺损面积20cm×9．7cm。结果股前外侧穿支皮瓣平均17．8cm×9．4cm，髂嗄股沟皮瓣平均8．4cm×4．5cm，髂骨膜骨瓣平均5．4cm×2．1cm×0．8cm，血管桥平均长10．5cm。1例髂骨骨皮瓣远端部分坏死，经换药后植皮愈合，余皮瓣顺利成活。10例患者均获得6-36个月（平均12个月）随访。手损伤者平均骨愈合时间3个月，平均臂肩手残疾问卷评分43分；足损伤者平均骨愈合时间4个月，13本外科协会足部疾患治疗效果评分平均71.3分；小腿损伤者平均骨愈合时间4．5个月，Puno等评分平均91分。供区瘢痕颜色白、平软，6例大腿瘢痕增宽，2例瘢痕周围有麻木感，3例髂腹股沟区瘢痕增宽。结论股前外侧穿支皮瓣桥接旋髂浅动脉蒂组织瓣移植可自由调整组织瓣位置，供区副损伤小，是修复大面积、结构复杂或类型特殊四肢骨与软组织缺损的一种较好方法。

Objective To investigate the application and clinical outcomes of anterolateral thigh perforator flap bridging different superficial circumflex iliac artery flaps for the treatment of complex limb wound. Methods Data of 10 patients, who had undergone free tissue transfer of anterolateral thigh perforator flap bridging different superficial circumflex iliac artery flaps （iliac osteocutaneous flap, iliac crest flap and ilioinguinal flap） for the complex limb wound from March 2009 to January 2011, were retrospectively analyzed. There were 9 males and 1 female, aged from 21 to 57 years （average, 39.7 years）. Iliac osteocuta- neous flap was used in 7 patients, iliac crest flap in 2 patients arid ilioinguinal flap in 1 patient. The free tissue transfer was performed for hand reconstruction in 3 cases, foot reconstruction in 4 cases and leg reconstruction in 3 cases. The mean size of soft tissue defect was 20 cm × 9.7 cm. Results The mean size of the anterolateral thigh flap and the ilioinguinal flap was 17.8 cm×9.4 cm and 8.4 cm×4.5 cm, respectively. The mean volume of iliac crest was 5.4 cm×2.1 cm×0.8 cm, and the mean length of flow-through conduit was 10.5 cm. Except for the distal necrosis of iliac osteocutaneous flap in 1 case, which were treated by dressing change and skin grafting, the other flaps survived without complications. All patients were followed up for 6 to 36 months （average, 12 months）. The average bone union time was 3 months in the hand group, 4 months in the foot group, and 4.5 months in the leg group. The disabilities of the arm, shoulder, and hand question- naire score averaged 43, the mean Japanese Orthopaedic Association＇s foot rating scale was 71.3, and the mean Puno＇s functional score was 91. Donor site scars were mostly flat, pale and soft but widened in the thigh in 6 patients and in the ilioinguinal region in 3 patients, and numbness was reported in 2 patients. Conclusion In clinical situation that requires for coverage of complex and extensive limb defects, the free tissue transfer of anterolateral thigh perforator flap bridging superficial circumflex iliac artery flap is a better method, which can meet specific reconstructive demands with minimal donor site morbidity. However, a relative high risk has to be considered.