不带阔筋膜的股前外侧穿支皮瓣修复四肢软组织缺损

Anterolateral thigh perforator flap without fascia lata for repair of soft tissue defects of the extremities

目的探讨不带阔筋膜的股前外侧穿支皮瓣修复四肢软组织缺损的临床效果。方法自2014年11月至2016年4月我科收治13例四肢软组织缺损患者，均采用不带阔筋膜的股前外侧穿支皮瓣修复创面，皮瓣大小12cm×5cm～33cm×11cm，术前均采用CT血管成像技术（computed tomography angiography，CTA）联合彩色多普勒超声（color doppler sonography，CDS）定位技术定位穿支血管位置，术后2例供区采用全厚皮片植皮，其余11例均一期直接缝合，术后常规石膏托外固定。结果1例皮瓣术后出现血管危象，重新吻合后存活；1例皮瓣远端坏死约5cm，二期切除后植皮；其余均完全存活。1例供区植皮部分液化坏死，换药处理后伤口愈合，其余12例均Ⅰ期愈合。随访3～17个月，平均7．7个月。2例二期行皮瓣修薄手术。结论不带阔筋膜的股前外侧穿支皮瓣修复四肢软组织创面成活率高，供区损伤小，外观不臃肿，适用于四肢软组织缺损的创面修复。

Objective To evaluate the clinical effects of transferring anterolateral thigh perforator flap （ALTP flap） without fascia lata for repairing soft tissue defects of the extremities. Methods Between November 2014 and April 2016, 13 cases of soft tissue defects of the extremities were treated by ALTP flap transfer without including the fascia lata. The area of flaps ranged from 12 cm×5 cm to 33 cm× 11 cm. Combined use of computed tomography angiography （CTA） and color Doppler sonography （CDS） preoperatively located the perforators. The donor site was primarily closed in 11 cases, while full thickness skin graft was needed in 2 cases. A plaster cast was applied in all the patients for postoperative immobilization. Results Vascular crisis occurred in one flap, which survived completely after successful vessel exploration and re-anastomosis. Distal skin necrosis of 5 cm occurred in another flap, which was healed after skin grafting. The rest of the flaps survived uneventfully. The donor sites achieved primary healing in 12 cases, whereas one case had skin graft necrosis and wound healing after dressing change. All the patients were follow-up for 3 to 17 months, with an average of 7.7 months. Only 2 cases needed secondary debulking of the flap. Conclusion Anterolateral thigh perforator flap without fascia lata is a suitable flap for repairing soft tissue defects of the extremities. It has high survival rate, satisfactory appearance, and low donor site morbidities.