游离股内侧区穿支皮瓣修复下肢软组织缺损

Free anteromedial thigh perforator flap transplantation for repairing soft tissue defect in lower extremity

目的探讨股内侧区穿支皮瓣修复下肢软组织缺损的临床效果。方法对2009年1月至2012年12月，应用股内侧区穿支皮瓣游离移植修复下肢软组织缺损患者12例，其中胫前创面5例，足背创面4例，足跟创面3例；创面大小为3．0cm×3．5cm～7．0cm×9．5em；皮瓣选择采用游离膝降动脉穿支皮瓣3例，游离股前内侧穿支皮瓣2例，股内侧肌穿支皮瓣7例。结果12例患者皮瓣全部成活。其中1例股前内侧穿支皮瓣、1例膝降动脉穿支皮瓣术后出现血管危象，经积极抗凝、抗痉挛处理后皮瓣成活；1例膝降动脉穿支皮瓣边缘部分坏死，经换药后痊愈。12例患者术后均获得6～12个月随访（平均8．6个月），皮瓣质地良好，外观、厚薄均匀合适；其中5例游离皮瓣吻合皮神经后感觉恢复至S3；12例供区直接缝合愈合，仅留线性瘢痕，功能无影响。结论股内侧区穿支皮瓣解剖恒定，操作便捷，修复下肢软组织缺损临床效果满意。

Objective To explore the clinical effect of anteromedial thigh perforator flap for repairing soft tissue defect in lower extremity. Methods From January 2009 to December 2012, 12 patients with soft tissue defect of lower extremity were treated with free anteromedial thigh perforator flap. Among them, there were 5 cases of wound in front of tibia, 4 eases of dorsal foot wound, 3 cases of heel wound ; the wound size was 3.0 cm ×3.5 cm-7. 0 cm × 9. 5 cm;3 cases were repaired with free perforator flap of descending genicular artery, 2 cases with free anteromedial thigh perforator flap, and 7 cases with medial vastus muscle perforator flap. Results All the transplants survived. Among them, 1 case of anteromedial thigh perforator flap and 1 case of descending genicular artery perforator flap appeared vascular crisis postoperative. After anticoagulation and antispasmodic treatment aggressively, the flaps survived. One case of descending genicular artery perforator flap necrosis in edge, and then were cured by changing dressing. Twelve cases were followed up 6-12 months after operation （average 8. 6 months）, and the texture of flaps were good, the appearance appropriate;7 sensation of 5 free flaps after nerve anastomosis came back to S3; the donor sites in all cases were sutured directly and healed, leaving only the linear scar, and no effect on function. Conclusion The anatomy of anteromedial thigh perforator flap is constant, and the operation is convenient. The clinical result of repairing soft tissue defect of lower extremity is satisfying.