股内侧肌穿支皮瓣修复游离股前外侧穿支皮瓣供区继发创面的临床效果

Clinical effects of perforating branch flaps of medial vastus muscle in repairing secondary wounds in donor sites of free anterolateral femoral perforator flaps

目的探讨应用股内侧肌穿支皮瓣修复游离股前外侧穿支皮瓣供区继发创面的临床效果。方法2014年8月-2016年12月,汉中市中心医院收治12例四肢皮肤软组织缺损伴肌腱、骨质外露患者,其中男8例、女4例,年龄35~72岁。原发创面清创后大小10cm×8cm^22cm×14cm,采用面积为12cm×10cm^24cm×16cm游离股前外侧穿支皮瓣修复。股前外侧供区利用皮肤延展性缝合后遗留继发创面8.0cm×4.0cm^14.0cm×7.5cm,均采用股内侧肌穿支皮瓣修复,皮瓣面积为9.0cm×5.0cm^15.0cm×8.5cm。股内侧供瓣区直接拉拢缝合。结果12例患者股内侧肌穿支皮瓣及游离股前外侧穿支皮瓣全部成活。术后随访6~12个月,股内侧肌穿支皮瓣局部外形、质地良好,未切断皮神经的8例患者皮瓣感觉灵敏,其余4例患者皮瓣感觉逐渐恢复,同侧膝关节功能均正常。结论股内侧肌穿支皮瓣解剖恒定、血供丰富,用其修复游离股前外侧穿支皮瓣供区继发创面操作便捷、安全、易于推广,术后外形功能较佳。

Objective To investigate the clinical effects of perforating branch flaps of medial vastus muscle in repairing secondary wounds in donor sites of free anterolateral femoral perforator flaps. Methods From August 2014 to December 2016, 12 patients (8 males and 4 females, aged 35-72 years) with skin and soft tissue defects of extremities associated with tendon and bone exposure were treated in Hanzhong Central Hospital. The sizes of the primary wounds after debridement were 10 cm×8 cm-22 cm×14 cm, and the wounds were repaired with 12 cm×10 cm-24 cm×16 cm free anterolateral femoral perforator flaps. The anterolateral femoral donor sites, which were 8.0 cm×4.0 cm-14.0 cm×7.5 cm in the secondary wounds after skin extensional suture, were repaired with perforating branch flaps of medial vastus muscle in the size of 9.0 cm×5.0 cm-15.0 cm×8.5 cm. The medial femoral donor sites were sutured directly. Results All the perforating branch flaps of medial vastus muscle and free anterolateral femoral perforator flaps survived in 12 patients. Following up for 6 to 12 months, the medial femoral perforator flaps had good local shape and texture. The flaps of 8 patients without cutaneous nerve transection were sensitive. The sensation of the flaps of the other 4 patients gradually recovered, and the functions of the ipsilateral knee joints were normal. Conclusions The medial femoral perforator flap has a stable anatomy and abundant blood supply, which can be used to repair the secondary wound in the donor site of the free anterolateral femoral perforator flap conveniently. It is safe and easy to be popularized. Moreover, it has a good shape and function after operation.