内增压型股前外侧双叶皮瓣修复四肢创面的临床应用

Clinical application of bilobed anterolateral thigh flaps with turbocharging technique in repairing limb wounds

目的探讨内增压型股前外侧双叶皮瓣修复四肢创面的临床效果。方法采用回顾性病例系列研究分析2014年3月—2019年7月苏州大学附属瑞华医院收治的29例四肢创面患者的临床资料,其中男26例,女3例;年龄22~60岁[(41.9±11.1)岁]。24例为四肢的单一创面,创面面积12 cm×10 cm^38 cm×27 cm;5例为2处相邻但不连续的创面,创面面积7 cm×4 cm^13 cm×9 cm。均设计、切取股前外侧双叶皮瓣,并使用内增压方式处理皮瓣所携穿支予以创面修复。记录皮瓣穿支来源、皮瓣切取时间及手术时间,观察皮瓣成活情况、供区愈合情况、远期皮瓣及供区外形、感觉恢复情况及并发症情况。结果患者均获随访6~64个月[(19.0±12.7)个月]。本组29例患者共设计30个双叶皮瓣。皮瓣切取时间25~60 min[(46.6±20.2)min]。手术时间4~11 h[(6.4±1.8)h]。术后1例1叶皮瓣发生静脉危象,经非手术治疗后成活,其余皮瓣均顺利成活。大腿供区均Ⅰ期愈合,愈合时间为11~53 d[(18.5±9.9)d]。4例因皮瓣外形臃肿于术后4~8个月行皮瓣修薄手术。末次随访时,皮瓣色泽质地良好,感觉部分恢复。供区均为线性瘢痕存留,1例瘢痕面积较大,但未出现瘢痕挛缩及疼痛等不适。2例术后早期出现切口区感觉异常,3个月后逐步恢复。无其他严重并发症发生。结论应用内增压型股前外侧双叶皮瓣修复四肢创面,可克服穿支不共干时不能设计切取双叶皮瓣的局限性,扩大双叶皮瓣的应用范围,同时减少供区切取宽度,有效避免供区并发症。

Objective To explore the clinical effect of bilobate anterolateral thigh flaps with turbocharging technique in repairing limb wounds.Methods A retrospective case series study was conducted to analyze the clinical data of 29 patients with complex wounds of limbs admitted to Ruihua Hospital Affiliated to Soochow University from March 2014 to July 2019.There were 26 males and 3 females,aged 22-60 years[(41.9±11.1)years].A total of 24 patients had singlewounds with the dimension of 12 cm×10 cm to 38 cm×27 cm,and 5 patients had two adjacent and discontinuous wounds with the area from 7 cm×4 cm to 13 cm×9 cm.The bilobate anterolateral thigh flaps with turbocharging technique were used.All the donor sites were directly sutured by primary closure.Routine treatment was given after operation.The origin artery of perforators,time of flap harvesting and operation time were recorded.The survival of the flap,healing of the donor area,long-term shape of the flap and donor area,sensory recovery and complications were observed.Results All patients were followed up for 6-64 months[(19.0±12.7)months].A total of 30 bilobed flaps were designed for the 29 patients.The time of flap harvesting ranged from 25 to 60 minutes[(46.6±20.2)minutes].The operation time was 4-11 hours[(6.4±1.8)hours].All flaps survived except one piece of a bilobed flap suffered from a vein crisis,which healed well after conservative treatment.These wounds\healing time ranged from 11 to 53 days[(18.5±9.9)days],and all the donor sites healed by first intention.Four patients underwent skin flap thinning operation 4 to 8 months later due to the bloated appearance of flaps.Acceptable cosmetic outcomes,soft and elastic skin,and sensation recovery were achieved at the final follow-up.All patients\donor area left linear scars.One patient had large scar area,but there was no scar contracture and pain.Two patients had an abnormal sensation in the incision area in the early stage and recovered gradually 3 months later without any other serious complications.Conclusions Repair of limb wounds with bilobed anterolateral thigh flaps with turbocharged technique can overcome the limitation that the bilobed flap can not be designed if the perforators do not share the same trunk and expand the application scope of the bilobed flaps.The design of bilobate flaps reduces the width of the donor site,which can effectively avoid the complications of the donor site.