血液循环增强技术在超大游离股前外侧皮瓣修复四肢大面积皮肤软组织缺损中的临床应用效果

Clinical application effect of blood circulation enhancement technique in repairing large area of skin and soft tissue defects of extremities with super large free anterolateral thigh flap

目的观察血液循环增强技术在超大游离股前外侧皮瓣修复四肢大面积皮肤软组织缺损中的临床应用效果。方法2014年3月—2017年3月,笔者单位收治6例四肢大面积皮肤软组织缺损患者,其中男5例、女1例,年龄27~65岁,电击伤1例、煤火烧伤2例、交通伤3例,累及上肢2例、下肢4例。清创后创面面积26cm×8cm^36cm×15cm,骨外露面积24cm×7cm^35cm×14cm。使用超大游离股前外侧皮瓣修复骨外露创面时应用血液循环增强技术,皮瓣面积为28cm×10cm^38cm×16cm。供瓣区及原发无骨外露创面取供瓣大腿内侧中厚皮片移植修复。记录术中血管增压方式及术后皮瓣存活情况,随访观察供受区恢复情况及并发症发生情况。结果3例患者皮瓣移植时采用单纯血管外增压技术,另外3例患者皮瓣移植时采用血管内、外增压联合技术。6例患者皮瓣全部存活良好,未发生血管危象。术后随访3~12个月,皮瓣血运良好,深浅感觉有不同程度恢复;除1例上肢皮瓣外,其余皮瓣无明显臃肿,无须二次修薄;供区仅有凹陷性瘢痕,皮片修复的无骨外露区无明显瘢痕增生;无近期或远期并发症。结论临床将血液循环增强技术应用于超大游离股前外侧皮瓣修复四肢大面积皮肤软组织缺损中,皮瓣血供可靠,术后效果较好,值得推广。

Objective To observe the clinical application effect of blood circulation enhancement technique in repairing large area of skin and soft tissue defects of extremities with super large free anterolateral thigh flap.Methods From March 2014 to March 2017,6 patients with large area of skin and soft tissue defects of extremities were hospitalized in our unit,including 5 males and 1 female,aged 27-65 years,1 case of electric injury,2 cases of coal burn,3 cases of traffic injury,2 cases involving upper limb,and 4 cases involving lower limb.After debridement,the wound area ranged from 26 cm×8 cm to 36 cm×15 cm,and the bone exposure area ranged from 24 cm×7 cm to 35 cm×14 cm.The blood circulation enhancement technique was used when the wound with bone exposure was repaired with super large free anterolateral thigh flap.The area of flaps ranged from 28 cm×10 cm to 38 cm×16 cm.The donor site of flap and the primary wound without bone exposure were repaired with medial thigh split-thickness skin graft of the donor leg of flap.The blood circulation enhancement technique mode during operation and the survival of flaps after operation were recorded,and the recovery of donor and recipient areas and the occurrence of complications were followed up.Results Three patients were treated with simple vascular supercharging technique during flap transplantation,and the other 3 patients were treated with vascular supercharging and turbocharging technique during flap transplantation.All the flaps survived well in 6 patients without vascular crisis.Follow-up for 3 to 12 months after surgery showed that the blood flow of the flaps was good and the depth and superficial sensation recovered to varying degrees.Except for 1 case of upper limb flap,the other flaps had no obvious swelling and needed no second thinning.There were only depressed scars in the donor sites,and no obvious scar hyperplasia in the area without bone exposure repaired by the skin grafts.No short-term or long-term complications were found.Conclusions The application of blood circulation enhancement technique in repairing large area of skin and soft tissue defects of extremities with super large free anterolateral thigh flaps provides reliable blood supply for the flaps and results in good effect after operation,which is worth popularizing.