股前外侧分叶-嵌合穿支皮瓣在四肢复杂创伤修复中的应用

Reconstruction of complex defects in extremities with the chimeric multi-paddled anterolateral thigh perforator flap

目的探讨以旋股外侧动脉降支(d-LCFA)为蒂的股前外侧分叶-嵌合穿支皮瓣在四肢复杂创伤修复中的可行性及临床效果。方法2010年8月至2017年12月,采用以d-LCFA为蒂的股前外侧分叶-嵌合穿支皮瓣修复四肢软组织缺损11例,其中车祸伤4例,机器绞伤2例,摔伤2例,犁田机绞压伤1例,重物砸伤1例,轮辐伤1例。所有创面均宽大(缺损大小为10.0 cm×9.0 cm^20.0 cm×18.0 cm)且合并不同程度的感染,清创后留有不同程度的死腔。设计股前外侧分叶-嵌合穿支皮瓣修复,股外侧肌瓣填充深部死腔,股前外侧分叶穿支皮瓣覆盖浅表宽大创面。分别于术后1、3、6、9、12个月随访,记录皮瓣的外形、颜色、质地以及伸膝功能和感染复发情况。结果受区术后均未出现血肿和继发感染。术后8例皮瓣顺利成活,供区一期愈合;1例因术中穿支蒂机械牵拉损伤,术后皮瓣发生部分坏死,予以患肢同侧d-LCFA嵌合穿支皮瓣修复;1例皮瓣术后发生静脉危象,经手术探查后皮瓣完全成活;1例修复手部创面术后皮瓣出现部分坏死,予以骨间后动脉穿支皮瓣游离移植修复。术后随访2~32个月,平均10.2个月,所有皮瓣颜色、质地良好,皮瓣供区仅留线形瘢痕,伸膝功能无影响。结论股前外侧分叶-嵌合穿支皮瓣减少了对供区的损害,简化了血运重建操作,提升了受区修复质量,是修复四肢复杂软组织缺损的一种可行方法。

Objective To investigate the feasibility and clinical effects of the chimeric multi-paddled anteriolateral thigh perforator flap(ALTP)for reconstruction of complex defects in extremities,which was pedicled with the descending branch of lateral circumflex femoral artery(d-LCFA).Methods From August,2010 to December,2017,11 cases of severe soft-tissue defects were repaired with this flap,including 4 cases of car accident trauma,2 of machine injury,2 of fall injuries,1 of ploughing machine injury,1 of crushing injury,and 1 of spoke injury.The injuries accompanied with different degrees of infections,dead space and left huge soft-tissue defects after radical debridement(10.0 cm×9.0 cm-20.0 cm×18.0 cm).Dead cavity was filled by the muscular flap,and the large area soft-tissue defects were repaired by chimeric multi-paddled perforator flap.Appearance,colour and texture of the flap,recurrence of infection and knee extension were recorded at 1,3,6,9 and 12 months follow-up.Results After the operation,all recipient sites had no hematoma and no infection.Eight flaps survived successfully,and donor sites healed primarily.One flap had partial necrosis because of a mechanical stretch of the perforator during the operation,then repaired by the ipsilateral chimeric perforator flap based on d-LCFA.One flap occurred vascular crisis on the second day after the surgery,and it was rescued and survived completely after surgical exploration.The other flap which repaired wound on hand had partial necrosis too,and then repaired with posterior interosseous artery perforator flap.The follow-up periods ranged from 2 to 32(mean,10.2)months.All flaps had satisfactory appearance and texture.Only linear scars left at the donor sites.There were no motion limitations at the hip and knee joints of the effected leg.Conclusion The anteriolateral thigh perforator flap combined with multi-paddled and chimeric techniques can reduce donor site morbidities,simplify the anastomosis of blood vessel,and improve the appearance and effects of the recipient site.It is a feasible method in repairing severe soft tissue defects of limbs.