改良薄型股前外侧穿支皮瓣修复手足部软组织缺损

Modified thin anterolateral thigh flaps for reconstruction of hand and foot defects

目的探讨改良薄型股前外侧穿支皮瓣的切取方法和临床效果。方法自2016年3月至2017年9月，应用改良薄型股前外侧穿支皮瓣修复手、足软组织缺损17例，修复手部缺损6例，其中3例手背缺损；修复足踝创面11例，其中5例为足背缺损。皮瓣面积为5 cm×3 cm^33 cm×10 cm。传统穿支皮瓣在深筋膜表面掀起皮瓣，断蒂前进行削薄或显微削薄，改良的方法是皮瓣在浅筋膜层大、小颗粒脂肪之间游离皮瓣，直接切取成薄型穿支皮瓣而无需削薄或显微削薄。最后一次门诊复查记录作为随访结果。 结果本组有3例皮瓣术后出现皮瓣下血肿，经二次探查止血后皮瓣得以成活；有2例皮瓣发生部分坏死，其中1例经换药后创面愈合，另1例二期经植皮后创面愈合。术后随访3~18（平均7）个月，17例皮瓣中的15例顺利成活，患者对修复外形满意，皮瓣质地薄而柔软，不臃肿。结论自浅筋膜层大、小颗粒脂肪之间切取皮瓣是一种安全可靠的方法；改良薄型股前外侧穿支皮瓣为直接切取薄的穿支皮瓣，减少术中削薄或二期削薄的几率，节省手术时间，减小了供区损伤，临床修复效果满意，特别适用于手背、足背及头颈等创面的修复。

ObjectiveTo evaluate the clinical efficacy of modified thin anterolateral thigh flaps for reconstruction of hand and foot defects.MethodsBetween March, 2016 and September, 2017, 17 patients were reconstructed with modified thin anterolateral thigh flap. There were 6 cases for reconstruction of hand, and 3 of them were located in the back dorsal of hand defects. There were 11 cases for reconstruction of ankle and foot, and 5 of them were located in the dorsal of foot. The size of the flap was 5 cm×3 cm-33 cm×10 cm. The traditional perforator flap was elevated just above the deep fascial plane. The debulking procedures could follow before the pedicle was cut off. The modified method was that the flap was elevated from the superficial fascia and the plane between deep and superficial fat without intraoperative debulking procedures.ResultsThree flaps were eventually survived after secondary exploratory operation caused by the hematoma. Two flaps had partial loss, 1 of which needed secondary skin grafting, and the other flap healed with additional intention. Followed-up period was 3-18（average, 7） months . All flaps showed relatively good contour and the patients were satisfied with clinical outcomes.ConclusionIt is a safe and reliable way that perforator flap can be elevated from the superficial fascia and the plane between deep and superficial fat. It can obtain a thin flap immediately and reduce donor-site morbidity without additional defatting and time-consuming. The flap is soft with good contour. This technique is an ideal option for covering defects composed of dorsal of the hand or foot and the head and neck regions.