股前外侧穿支皮瓣在手部大面积皮肤软组织缺损中的应用

Application of anterolateral femoral perforator flap in repair of skin and soft tissue defect of hand

目的探讨股前外侧穿支皮瓣在手部皮肤软组织缺损的治疗效果。方法选取2014年3月-2017年9月治疗的手部软组织缺损18例,采取股前外侧穿支皮瓣修复并Ⅰ期修复或重建指伸肌腱。记录受区皮瓣成活情况及供区皮瓣的面积、供区并发症的发生情况、皮瓣外观的评价、手部指伸肌腱重建后肌力及掌指关节活动度。结果术后随访6～18个月,平均(8.3±2.1)个月,18例皮瓣均成活,无坏死。术后供区切口感染3例,经口服抗生素、清创换药及控制血糖后感染情况均好转;肌肉部分坏死2例,经彻底清创后伤口愈合;瘢痕增生3例,但无碍功能活动;瘙痒2例;色素沉着4例;受区区感觉异常4例。患者对皮瓣外观的评价结果显示满意16例,不满意2例,满意度为88.9%。18例末次随访时手部指伸肌腱重建后肌力分级:3级14例,4级4例;掌指关节活动度40°～80°,平均66.2°±3.0°。结论股前外侧穿支皮瓣供区隐蔽,可供切取面积大,可有效修复手部软组织缺损,同时利用部分髂胫束编织后予以Ⅰ期重建指伸肌腱,解决了肌腱缺损的问题,并取得了较满意的疗效。

Objective To explore the therapeutic effect of the thinning anterolateral femoral perforator flap on the soft tissue defect of the hand. Methods A total of 18 patients with soft tissue defects on the back of the hand who were treated in our hospital from March 2014 to January 2018 were september 2017. The anterior thigh perforator flap was used to repair the soft tissue defect of the hand and to repair or reconstruct the tendon. Record the survival of the flaps in the affected area and the area of the flaps in the donor site, the occurrence of complications in the donor site, the evaluation of the appearance of the flap, the strength of the extensor tendons of the hand and the mobility of the metacarpophalangeal joints after reconstruction. Results The patients were followed up for 6-18 months with the average of （8.3±2.1） months. At the last follow-up, all patients received flaps without any necrosis. The area of the flaps in the donor site was 7 cm×10 cm×14 cm×19 cm. There were 10 incision infections in the donor site after operation. After oral antibiotics and timely debridement dressing and blood glucose control, the infection was improved. There were 2 cases of partial muscle necrosis. The wound healed after thorough debridement; 3 cases had scar hyperplasia, but no Impaired functional activity occured; 2 cases had itching; 4 cases had pigmentation; 4 cases had sensory abnormalities in the skin graft area. The results of evaluation of the patient＇s flap appearance were satisfactory in 16 cases and unsatisfactory in 2 cases. The excellent and good rate was 88.9%. At the final follow-up of 18 patients, the muscle strength grading distribution of the reconstructed hand extensor tendon at the final follow-up with the： 2 cases in grade 3, 9 cases in grade 4,and the degree of motion of the metacarpophalangeal joint was 40°±80° with the average （66.2° ±3.0°）. Conclusion The thinning anterolateral thigh flap hasthe advantages of donor concealment, large available cutting area. It is the first choice for the repair of soft tissue defects in the hand. The usage of partial iliotibial band to weave and primarily reconstruct, digital extensor can solve the problem of tendon defect at the same time, and can achieve satisfactory clinical effect.