股前外侧皮瓣修复儿童足踝部皮肤软组织缺损

Repair of foot and ankle skin soft tissue defects in children by implementation of anterolateral thigh flap

目的探讨采用股前外侧皮瓣游离修复儿童患者足踝部皮肤软组织缺损的临床疗效。方法自2017年1月至2018年10月,采用股前外侧皮瓣游离修复7例儿童患者足踝部皮肤软组织缺损,缺损面积3.0cm×4.5cm^4.5cm×10.0cm,均伴有肌腱及骨质外露。术前采用超声多普勒探测仪确定穿支点,切取股前外皮瓣面积4.0cm×5.5cm^5.5cm×11.0cm,4例供区创面直接拉拢缝合,3例需取中厚皮片植皮闭合创面。术后定期随访,评估皮瓣外观、质地及足踝部功能恢复情况。结果 7例皮瓣全部成活,创面一期愈合。其中1例发生血管危象,经手术探查,在吻合口处取出血栓后皮瓣成活;1例皮瓣远端坏死,经换药处理后,创面愈合良好。随访6~12个月,皮瓣外观良好,质地柔软,与周围皮肤组织基本一致,无臃肿,踝关节屈伸功能良好,足部静脉回流无影响。结论应用股前外侧皮瓣游离移植修复儿童足踝部皮肤软组织缺损,临床效果良好。

Objective To explore the clinical efficacy of anterolateral thigh flap transplantation in the repair of skin and soft tissue defects of the feet and ankles in children. Methods From January 2017 to October 2018, the anterolateral thigh flaps were used to repair skin and soft tissue defects of the feet and ankles in 7 children. The defect area ranged from 3.0 cm×4.5 cm to 4.5 cm×10.0 cm, all accompanied with exposure of tendon and bone. Preoperatively, the perforators were determined by ultrasonic doppler sonography. The anterolateral thigh flap was cut, with an area from 4.0 cm×5.5 cm to 5.5 cm×11.0 cm. The donor site wound was directly sutured in 4 cases,and intermediate split thickness skin graft was used to close the wound in 3 cases. Postoperative follow-up was conducted regularly to evaluate the appearance, texture, and functional recovery of the feet and ankles. Results All flaps survived in 7 children, and the wounds healed in the first stage. One patient experienced vascular crisis, but the flap survived after a thrombus was taken out at the anastomotic site. One case had necrosis of the distal end of the flap but healed well after dressing change. The follow-up period was from 6 to 12 months.The skin flap had good appearance and soft texture, basically consistent with the surrounding skin tissue. No edema occurred. The ankle joint had good flexion and extension function, with no effect on foot venous reflux. Conclusion The free anterolateral thigh flap has good clinical effect in the repair of skin and soft tissue defects of children’s feet and ankles.