旋股外侧动脉降支逆行供血的血流动力学研究及应用

The hemodynamics study and application of the reversed descending branch of lateral circumflex femoral artery

【摘要】目的通过对旋股外侧动脉降支逆行供血的血流动力学研究，探讨其作为受区供血血管，携带游离组织皮瓣修复小腿严重创伤后大面积皮肤软组织缺损的临床治疗效果。方法2005年10月至2012年2月，收治38例小腿软组织严重损伤患者，在术中对其中的16例16侧旋股外侧动脉降支转移前和逆行转移后的平均动脉压进行测量。所有患者均伴有严重的软组织、血管和（或）神经损伤，小腿无可与游离组织瓣相吻合的血管，不同程度的骨质、肌腱外露和（或）骨髓炎。采用游离组织皮瓣，包括背阔肌肌皮瓣、胸脐皮瓣、股前外侧皮瓣修复缺损，以逆行旋股外侧动脉降支作为受区供血血管。供区直接缝合或以中厚皮片移植修复。结果16例16侧旋股外侧动脉降支转移前的近端顺行平均动脉压值为（81．6ztz12．4）mmHg，血管转移后的近端逆行平均动脉压值为（48．2±10．7）mmHg，为转位前平均动脉压值的59．07％，下降了40．93％。38例患者术后皮瓣全部成活，切口一期愈合。术后2例出现皮瓣边缘部分坏死，经换药后愈合；其余皮瓣均顺利成活，无一例出现血管危象，创面一期愈合。供区切口及移植皮片均一期愈合。术后38例均获得随访，时间为11个月至2．5年，平均1．6年。皮瓣外形、质地、厚薄及色泽均较满意。结论旋股外侧动脉降支逆行供血的动脉血压压力充足，逆行供血是可行的。以逆行旋股外侧动脉降支为受区供血血管，携带游离组织瓣为临床治疗小腿严重创伤后大面积皮肤软组织缺损提供了一种新的治疗方法，效果确切。

Objective To investigate the hemodynamics evidence of the descending branch of lateral circumflex femoral artery in a reversed way. To explore the clinical result of using the reversed descending branch of the lateral circumflex femoral artery as the receipt artery for free flaps for reconstruction of the leg soft-tissue defect. Methods From October 2005 to February 2012, 38 patients with severe leg soft-tissue defects were treated. The proximal antegrade and retrograde mean artery pressure of the descending branch of the lateral circumflex femoral artery in 16 of 38 patients were recorded during operation. All wounds had osteomyelitis, bone and tendon exposure requiring coverage reconstruction. And there was no recipient artery in the injured lower leg for free flaps in all 38 patients. Reversed descending branches of lateral femoral circumflex arteries were used as recipient arteries for free flaps （free latissimus dorsi flap, free thoracoumbilical flap, and free anterolateral thigh flap） in all patients. The flap donor site