游离股前外侧嵌合皮瓣修复手部深部创面

Free chimeric anterolateral thigh flap for reconstruction of deep wounds of the hand

目的探讨游离股前外侧嵌合皮瓣修复手部深部创面的临床应用及效果。方法自2009年7月至2014年9月，采用游离股前外侧嵌合皮瓣修复手部深部创面11例。所有病例均存在皮肤缺损，伴深在死腔9例，贯通性软组织缺损2例。手部皮肤缺损面积6．5cm×2．3cm～13．0cm×6．5cm。所有病例均为二期修复。结果术后11例皮瓣全部存活，1例受区伤口感染，1例发生伤口周围湿疹。术后平均随访9个月（6—14个月），其中7例回医院随访。8例术后皮瓣外形、质地良好；3例术后皮瓣外形早期部分臃肿，3个月后逐渐改善，无需修薄术。皮瓣供区大腿无明显活动障碍，1例出现瘢痕增生。结论游离股前外侧嵌合皮瓣是治疗手部深在创面的有效方法。

Objective To investigate the clinical efficacy of using free chimeric anterolateral thigh flap for reconstruction of deep wounds of the hand. Methods From July 2009 to September 2014, free chimeric anterolateral thigh flap was transferred to repair deep wounds of the hand in 11 cases. All the cases presented skin defect, among which 9 had deep dead space and 2 had penetrating defects. The size of the skin defects ranged from 6.5 cm × 2.3 cm to 13.0 cm × 6.5 cm. All reconstructive surgeries were conducted subacutely. Results All 11 flaps survived. Recipient site wound infection occurred in one case, while eczema occurred around the flap in another case. The mean follow-up period was 9 months （range, 6 to 14 months）. Seven of them were follow-up in the outpatient department. The texture and appearance of the flap was satisfactory in 8 cases. Slight bulkiness occurred in 3 cases which gradually atrophied at 3 months postoperatively. No debulking surgery was necessary. No patient had complained of any functional compromise of the donor leg. Keloid at the donor site was seen in one case. Conclusion Transfer of chimeric anterolateral thigh flap is an effective method for reconstruction of deep wounds of the hand.