改良游离隐动脉穿支皮瓣修复四肢皮肤软组织缺损

Repair of Soft Tissue Defects of Extremities with Improved Free Saphenous Artery Perforator Flap

目的探讨应用改良游离隐动脉穿支皮瓣修复四肢皮肤软组织缺损的临床效果。方法选择各种创伤造成的四肢皮肤软组织缺损患者21例,皮肤软组织缺损面积为17 cm×8.5 cm^6.5 cm×4.5 cm;受伤至入院时间为1~6 h,平均3 h。均采用改良游离隐动脉穿支皮瓣进行修复,其中急诊修复12例,亚急诊修复9例。皮瓣切取面积为18 cm×9 cm^7 cm×5 cm。供区直接缝合。结果术后21例皮瓣全部顺利成活。随访6~24个月,平均15个月。皮瓣外形不臃肿,质地柔软,有弹性,色泽良好。皮瓣感觉功能参照英国医学研究院神经外伤学会(MCRR)感觉功能评定标准为S+3,两点辨别觉6~10 cm。供区仅留线形瘢痕,膝关节活动范围为伸10°~屈130°,功能正常,下肢感觉及静脉回流良好。结论改良游离隐动脉穿支皮瓣薄而柔软,外形美观,解剖分离相对简单,不损伤主干血管,可恢复感觉,增加耐磨性,供区隐蔽、损伤小,是修复四肢中等面积皮肤软组织缺损的一种理想选择。

Objective To discuss the clinical efficacy of improved free saphenous artery perforator flap for covering soft tissue defects in extremities.Methods The improved free saphenous artery perforator flap was used to repair traumatic soft tissue defects of extremities(defect area,17 cm×8.5 cm-6.5 cm×4.5 cm;flap area,18 cm×9 cm-7 cm×5 cm)in 21 patients(time from injury to admission,1-6 hours;average,3 hours),including 12 cases of emergency repair and 9 cases of sub-emergency repair.The donor sites were sutured directly.Results All the 21 flaps survived completely with flat appearance,appropriate color and soft and elastic texture.Patients were followed up for 6-24 months(average,15 months).According to the British Medical Research Institute Neurological Trauma Society(MCRR)score system,the sensory function of flaps was rated as S+3.The two-point discrimination ranged from 6 to 10 cm.Only leaner scar was observed in donor site.Patients had normal knee joint function and good lower extremity sensation and venous reflux.The motion of the knee joint ranged from 10 degrees of extension to 130 degrees of flexion.Conclusion The improved free saphenous artery flap provides an ideal option for covering soft tissue defects in extremities.The flap repair is characterized by thin and soft texture,aesthetic appearance,simple flap dissection,intact main vessels,satisfactory sensory recovery,increased wear resistance,conceal donor location and little damage.