带阔筋膜的股前外侧皮瓣Ⅰ期修复合并伸肌腱缺损的手足背创面

Clinical application of anterolateral thigh flap with fascia lata to reconstruct the dorsal defect of the hand or foot with extensor tendons defect

目的 探讨带阔筋膜的股前外侧皮瓣Ⅰ期修复合并伸肌腱缺损的手足背创面、重建伸指(趾)功能的临床效果.方法 自2008年9月至2017年8月应用带阔筋膜的股前外侧皮瓣修复合并伸肌腱缺损的手足背创面共7例(手部3例,足部4例).根据缺损创面的大小及伸肌腱缺损长度游离切取带阔筋膜的股前外侧皮瓣;手或足保持功能位,将带血供的阔筋膜卷曲或折叠,用其两端包绕缺损伸肌腱的远、近端,然后采用编织缝合法进行吻合;皮瓣内的血管、神经与受区血管、神经进行吻合;最后间断缝合直接关闭供区.结果 7例皮瓣均成活.按美国手外科学会推荐的TAM(total active movement)评定标准或MFS(maryland foot score)标准进行功能评价,优2例,良3例,可2例.供区仅留一线性瘢痕.患者对功能恢复及外观满意.结论 带阔筋膜的股前外侧皮瓣可以同时修复手背或足背侧创面并重建伸指(趾)功能,且兼具疗程短、供区损伤小的特点,是一种修复合并伸肌腱缺损的手足背创面的可靠手术方法.

Objective To evaluate the clinical efficacy of anterolateral thigh flap combined with fascia lata for one-stage repair of dorsal hand or foot wound with extensor tendon defect.Methods From September 2008 to August 2017,7 patients suffered dorsal hand or foot wounds were reconstructed using anterolateral thigh flaps combined with fascia lata(3 cases in hands and 4 cases in feet).The anterolateral thigh flaps with fascia lata were cut off,according to the size of wound and the length of defected extensor tendon.The hand or foot was kept in the functional position,thenthe vascularized fascia lata were curled or folded,andwrapped the distal and proximal ends of the defect extensor tendon,and anastomosed using knitting suture method.The blood vessels and nerves in the flapswere anastomosed to that in the recipient area.Finally,the donor site by discontinuous suturewere closed.Results All flaps were survived.According to the TAM(total active movement)or MFS(maryland foot score)criteria recommended by the American Society of Hand Surgery,the results of 2 cases were excellent,3 cases were good and 2 cases were fair.There was only one line scar in the donor site.All the patients were satisfied with functional recovery and appearance.Conclusion Anterolateral thigh flap combined with fascia lata can be used to repair the dorsal hand or foot wounds and reconstruct the function of extensor finger(toe).It has the characteristics of short course of treatment and less damage to donor site.It is a reliable surgical method for repairing dorsal hand or foot wounds with extensor tendon defect.