游离股前外侧筋膜皮瓣一期修复伴肌腱缺损的手足创伤

Clinical application of the free anterolateral thigh myocutaneous flap with the tensor fascia lata for one-stage repair of soft tissues defects at the dorsum of hands （feets）

目的探讨应用带阔筋膜的股前外侧皮瓣游离移植一期修复手（足）背部皮肤软组织伴指（趾）伸肌腱缺损创面的方法及临床效果。方法2010年1月至2014年12月，收治8例手（足）背部皮肤软组织缺损患者，创面面积6cm×5cm～18cm×10cm，均合并部分指（趾）伸肌腱缺损，一期手术采用8cm×7cm-20cm×12cm的股前外侧皮瓣修复创面，同时利用阔筋膜桥接指（趾）长伸肌腱两断端。供区直接拉拢缝合或取中厚皮片移植修复。术后2～3个月二期手术松解肌腱、阔筋膜，并将阔筋膜分割制成肌腱样形态，术后加强指（趾）功能锻炼。结果一期术后皮瓣均成活，均获6～12个月随访，平均8个月。4例皮瓣稍臃肿，其余皮瓣外形满意；皮瓣质地柔软，随访期间3例修复手指指伸肌腱装置的患者恢复了部分背伸功能，背伸5°～40°，屈曲功能基本正常；5例修复足背创面患者行走正常，无足趾下垂畸形发生。结论应用带阔筋膜的股前外侧皮瓣游离移植一期修复手（足）背部皮肤软组织伴指（趾）伸肌腱缺损创面，治疗时间短、对供区损伤小，并可同期修复指伸肌腱装置和部分伸趾功能。

Objective To explore the method and the therapeutic effect of the free anterolateral thigh myocutaneous flap with the tensor fascia lata for one - stage repair of soft tissues defects at the dorsum of hands （feets）. Method Between Jan. 2010 and Dec. 014, 8 patients with finger （toe） extensor tendon and dorsal foot defect were treated with anterolateral thigh myocutaneous flap. The defect area ranged from 6 cm ×5cm to 18 cm × 10cm. All of the soft tissues defects at the dorsum of hands （feets） combined with tendon colobomam. The free anterolateral thigh myocutaneous flap（ ranged from 8 cm × 7cm to 20 cm× 12cm） were applied for one - stage repair of the soft tissues defects. The anterolateral thigh flap was used to repair defect and fascia lata was used to bridge two ends of digitorum longus tendon. The defects at donor sites were sutured directly or repaired with the split - thickness skin graft. 2 - 3 months after the surgery, tenolysis for tendon was performed, and fascia lata was split into tendon - like shape and the finger （toe） functional exercises were done. Results All flaps survived completely after the first stage. Postoperative follow-up time was 6 - 12 months （ average, 8 months）. Except 4 flaps with somewhat swelling, the other flaps had satisfactory appearance with soft texture. During the follow - up, part of the dorsiflexion function of hand recovered in 3 patients （5° -40°）, and flexion function was normal; 5 patients with soft tissues defects at the dorsum of loots could walk normally with no toe ptosis. Conclusions Application of the free anterolateral thigh myoeutaneous flap with the tensor fascia lata can repair soft tissues defects at the dorsum of hands （feets） combined with tendon colobomam. It can repair soft tissues defect combined with finger （toe） extensor tendon defects. Excellent clinical results can be achieved with short treatment time and less damage to the donor site.