旋股外侧动脉斜支穿支皮瓣供区闭合方式探讨

A study of the closed approach inlateral circumflex femoral artery oblique branch perforator flaps donors

目的探讨旋股外侧动脉斜支穿支皮瓣供区创面的闭合方式,以减少供区并发症。方法闭合创面方式包括:皮下潜行分离后直接拉拢缝合、皮下潜行分离后植皮修复、带蒂旋股外侧动脉降支穿支皮瓣转移修复以及带蒂旋髂浅动脉穿支皮瓣转移修复。缺损部位包括前臂及手背5例、小腿5例和足部8例。软组织缺损范围为4.0 cm×9.0 cm^10.0 cm×29.0 cm。斜支穿支皮瓣切取范围5.0 cm×11.0 cm^11.0 cm×33.5 cm。结果所有患者获随访1~6个月,皮瓣、皮片均完全成活,切口一期愈合。植皮患者残留1.5 cm瘢痕,直接缝合和穿支皮瓣修复者供区术后为线状瘢痕。髋膝关节活动自如,行走未见肌力减退。供瓣区留下不同程度感觉障碍区,植皮和穿支皮瓣修复者供区感觉麻木较明显,供区直接缝合者感觉障碍范围较小。结论旋股外侧动脉斜支穿支皮瓣供区直接缝合可降低皮瓣感觉障碍,对于面积较大供区可采用邻近区域穿支皮瓣修复,以达到最佳外观。

Objective To explore the closed approach inlateral circumflex femoral artery oblique branch perforator flaps donors to reduce complications.Methods Direct suture after subcutaneous sneak separation,skin graft after subcutaneous sneak separation,pedicled lateral circumflex femoral artery descending branch perforator flap,and pedicled superficial circumflex iliac artery perforator flaps were used to repair the defect.Treatment was administered to five cases of forearm injury with injury to the back of the hand,5 cases of shank crush injury,and 8 cases of foot injury.The soft tissue defect area ranged from 4.0 cm × 9.0 cm to 10.0 cm× 29.0 cm.The incision area of the lateral circumflex femoral artery oblique branch perforator flaps ranged from 5.0 cm x 11.0 cm to 11.0 cm × 33.5 cm.Results All patients were followed-up from 1 to 6 months.All flaps and skin grafts survived completely,and the incision s healed primarily.Patients who underwent skin grafting retained a 1.5 cm scar,and the other patients＇donor sites retained linear scars.The hip and knee joint could move freely with no muscle weakness.There were different degrees of sensory disturbance in the donor sites.The recipient site of the skin graft and skin flap sense obvious numbness.There was a small degree of sensory disturbance in patients who underwent direct sutures of the donor site.Conclusion There were a number of approaches for the closure of the donor lateral circumflex femoral artery oblique branch perforator flaps.Direct suture can reduce the occurrence of complications.