应用股前外侧Flow-through皮瓣同时修复肢体软组织并主干血管缺损

Application of anterolateral thigh flow-through flaps for simultaneous repair of soft tissue and main vascular defects of extremities

目的总结应用股前外侧Flow-through皮瓣同时修复肢体软组织并主干血管缺损的手术方法和临床疗效。方法自2009年4月至2017年5月,应用股前外侧Flow-through皮瓣修复7例肢体软组织并主干血管缺损伤患者。应用股前外侧穿支皮瓣覆盖肢体皮肤软组织缺损的同时,将旋股外侧动脉降支与缺损的主干动脉桥接,以重建血液循环。皮肤软组织缺损范围为5.0 cm×4.5 cm-21.0 cm×11.0 cm,主干血管缺损范围为2.5~11.0 cm,切取皮瓣大小为6.5 cm×5.5 cm^23.0 cm×12.0 cm.对于合并主要神经或肌肉、肌腱缺损,或存在死腔者,予移植腓肠神经或同时切取股外侧肌肌瓣或股直肌肌腱瓣嵌合移植修复。结果本组1例在游离皮瓣过程中误伤穿支血管,立即予吻合;1例术后发生血管危象经手术探查后解除,其余皮瓣及肢体均顺利存活。术后随访6~36个月,平均12个月。1例术后半年患肢远端轻度萎缩,但无明显功能影响,于1年、2年追踪随访再无加重;其余肢体均恢复基本外形及屈伸功能,皮瓣外形、质地均良好,恢复保护性感觉。供区除线性瘢痕或色素沉着外,无功能影响。上肢功能根据Berten评定标准:优2例,良1例,可2例;下肢根据美国足踝外科协会Maryland评分标准:优、良各1例。结论应用股前外侧Flow-through皮瓣同时修复肢体软组织并主干血管缺损,在修复肢体创面或复合组织缺损的同时,可桥接重建肢体主干血管。将本来需要分期多次或牺牲多个供区才能完成的手术,应用一个供区一次性完成;缩短了病程,为患肢功能康复赢得时间,而且减轻了患者的痛苦及家庭的经济负担。值得推广。

Objective To summarize the operative method and clinical efficacy of anterolateral thigh flow-through flap for simultaneous repair of soft tissue and main vascular defects of extremities.Methods From April 2009 to May 2017,7 patients with soft tissue defects and main vessel defects were treated with anterolateral thigh flow-through flaps.The anterolateral thigh flow-through flaps were used to cover the skin and soft tissue defects of limbs,and the descending branch of the lateral circumflex femoral artery was bridged with the defective main artery to reconstruct the blood circulation.The skin and soft tissue defects ranged from 5.0 cm×4.5 cm to 21.0 cm×11.0 cm.The trunk vascular defects ranged from 2.5 to 11.0 cm.The area of skin flaps ranged from 6.5 cm×5.5 cm to 23.0 cm×12.0 cm.For those with major nerve or muscle or tendon defect or dead space,sural nerve or lateral femoral muscle or rectus femoris muscle tendon flaps were transplanted to repair the defect.Results The perforator vessels were accidentally injured in the process of free flap in one case,and anastomosis was performed immediately.The vascular crisis occurred in one case and was relieved after surgical exploration.The remaining flaps and limbs survived smoothly.The postoperative follow-up ranged from 6 to 36 months,with an average of 12 months.One patient suffered from mild atrophy of the distal limb half a year after operation,but there was no significant functional impact.The follow-up for 1 or 2 years showed no aggravation.The rest of the limbs recovered their basic shape and flexion and extension function.The appearance and texture of the skin flaps were good,and the sensation of protection was restored.The donor site had no functional effect except linear scar or pigmentation.According to the Berton criteria,the upper limb function was evaluated as excellent in 2 cases,good in 1 case and fair in 2 cases.According to the Maryland criteria of the American foot and ankle surgery association,the lower limb function was evaluated as excellent in 1 case and good in 1 case.Conclusion The anterolateral thigh flow-through flap can be used to repair the soft tissue and main vessel defect of the extremity simultaneously.It can bridge and reconstruct the main vessel of the extremity while repairing the wound or composite tissue defect of the extremity.The operation that should be performed by stages or at the expense of multiple donor sites should be performed by one donor site at a time.It shortens the course of disease,gains time for the recovery of extremity function,and reduces the pain of patients and the economic burden of families.It's worth promoting.