应用开槽式血管蒂法进行游离组织瓣移植修复下肢软组织缺损的临床应用

The Application of Putting Vascular Pedicle Under Slotted Skin to Treat Tissue Defects with Free Flaps on Lower Limbs

目的：探讨通过开槽式放置吻合血管蒂的方法进行游离皮瓣移植修复下肢创面的临床经验和临床价值。方法设计应用皮肤开槽的方法，把吻合血管后的血管蒂放置于皮肤皮下槽沟内，成功完成组织瓣的游离移植并避免了血管蒂受压。2007年8月至2012年5月，临床应用吻合血管游离组织瓣313例病例，其中应用开槽式血管蒂处置法51例，男32例，女19例，年龄23-68岁，创面位于足部11例，踝部13例，足部及踝部两处以上创面11例，小腿部18例；应用股前外侧皮瓣50例，其中分叶皮瓣13例，腓浅动脉穿支皮瓣1例。结果50例皮瓣均成活，1例股前外侧分叶皮瓣的一个皮瓣出现部分皮肤缺血坏死，深部组织成活良好，经二期植皮后创面愈合。术后51例患者均获得随访，无血管危象发生，血管蒂于术后1周被肉芽组织覆盖，约3-6周被皮肤组织完全覆盖，外观平整，随访3-8个月，外形满意，皮瓣质地柔软。结论应用开槽式血管蒂放置法进行吻合血管的游离组织瓣移植修复下肢创面是切实可行的，具有操作简单、安全有效的优点。

Objective To exploring clinical experience and valuement of putting anatomotic vascular pedicle under slotted skin to treat tissue defect with free lfaps on lower limbs. Metods The skin was grooved and the anatomotic vascular pedicle was putted in subcutaneous groove.From august 2007 to may 2012,313 cases were used vascularized free tissue lfaps.Among the total,51 cases, pedicles were putted in subcutaneous groove.Thirty-two patients were males and nighteen were females with ages from 23 to 68 years old. Eleven paitiets, wounds were on feet,thirteen on ankles, nighteen on cnemis,and eleven on both ankles and cnemis.Fifty cases used anterolateral thigh lfaps including eleven ramiifed lfaps,one used superifcial peroneal artery perforator lfap. Results Fifty lfaps survived,and one part of a ramiifed lfap came with ischemic necrosis of part skin,but its deep tissue survived well and the wound healed after secondary dermatoplasty. No vascular crisis happened,the vascular pedicles were covered with granulation tissue one week postoperation,and covered withe skin tissue about 3-6 weeks postoperation with smooth appearance. Conclusion It is feasible to put vascular pedicle under slotted skin to treat tissue defects with free lfaps on lower limbs with advantages of simpleness, safety and effect.