旋股外侧动脉外侧支在股前外侧穿支皮瓣中的临床应用

Clinical application of the lateral branch of lateral circumflex femoral artery in the anterolateral thigh perforator flap

目的探讨以旋股外侧动脉外侧支为蒂的股前外侧穿支皮瓣在四肢软组织缺损修复术中的可行性与技术要点.方法自2014年5月至2018年5月,共完成股前外侧穿支皮瓣移植修复软组织缺损86例,其中利用以旋股外侧动脉外侧支为蒂的穿支皮瓣修复四肢软组织缺损37例:上肢19例,下肢18例;缺损原因:外伤27例,软组织肿瘤切除后创面10例;缺损范围:9.0cm×6.0cm^26.0cm×10.0cm.皮瓣以髂髌线中点近侧5.0~7.0cm为中心进行设计,皮瓣切取范围10.0cm×7.0cm^27.0cm×11.0cm.血管蒂长度为7.0~13.0cm,平均11.5cm.供瓣区均采用直接拉拢缝合的方式闭合.术后定期门诊随访.结果所有患者术后皮瓣全部成活,供瓣区伤口均一期愈合,其中2例外伤和2例术前局部放疗后患者的受瓣区伤口延迟愈合,经过多次换药最终痊愈.37例均获随访,时间3~26个月,平均13个月.皮瓣质地优良、外形满意,颜色、弹性与受区周围软组织接近;供瓣区仅留线形瘢痕.10例肿瘤患者皮瓣修复术后进行常规放、化疗,随访期间无肿瘤复发.结论旋股外侧动脉外侧支在髂髌线中点近端5.0~7.0cm发出1条较为粗大的穿支血管,位于旋股外侧动脉降支的上外侧,与股外侧肌平行,并发出皮肤穿支与肌支.以旋股外侧动脉外侧支为蒂可设计穿支皮瓣或嵌合皮瓣,为股前外侧穿支皮瓣移植增加了一种新的血管蒂选择,尤其在降支没有发出粗大皮穿支时,更凸显出其重要的实用价值,值得临床推广应用.

Objective To investigate the feasibility and technique of using the anterolateral thigh perforator flap pedicled with the lateral branch of the lateral circumflex femoral artery (LBLCFA) to repair soft tissue defect of extremities.Methods Eighty-six cases of anterolateral thigh perforator flap transplantation were performed from May,2014 to May,2018.A total of 37 cases of soft tissue defect of extremities were treated by anterolateral thigh perforator flap used the LBLCFA as vascular pedicle,of which there were 19 cases of upper limbs and 18 of lower limbs.There were 27 cases of defects caused by trauma,and 10 by soft tissue tumor resection.The flaps were designed centering around the point proximal to the midpoint of the iliac-patellar line.The dimensions of soft tissue defect were from 9.0 cm×6.0 cm to 26.0 cm×10.0 cm,and the flap were from 10.0 cm×7.0 cm to 27.0 cm×11.0 cm.The length of vascular pedicle ranged of 7.0-13.0 cm,with an average of 11.5 cm.The donor sites were directly sutured.All of the patients were followed-up regularly in the outpatient department.Results All the flaps survived and the donor sites were primarily healed.Of these 37 cases,2 trauma patients and 2 patients treated with local radiotherapy had poor wound healing,but still healed after multiple dressing changes.All the patients were followed-up for 3-26 months,with an average of 13 months.The texture,color and elasticity of the flap were similar to the surrounding tissue of the recipient sites,while only a linear scar remained at the donor sites.Ten tumor patients were treated with routine radiotherapy and chemotherapy after the repairation;there was no tumor recurrence during the follow-up period.Conclusion The LBLCFA gives off a relatively large and thick perforator proximal 5.0-7.0 cm of the iliacpatellar line,which locates in the upper lateral side,travels parallel to the vastus lateralis,and give off the skin and muscular perforators.The lateral branch can be used as pedicle to make into perforator flap or chimeric flap,which provides a novel selection of vascular pedicel for anterolateral thigh perforator flap.When the descending branch does not provide a thick and large perforator,the LBLCFA has important practical value and is worth utilizing in the clinic.