双侧旋股外侧动脉降支穿支皮瓣组合移植修复下肢大面积软组织缺损

Repairation of large soft tissue defects of lower limbs with combined transplantation of bilateral perforator flap based on the descending branch of lateral circumflex femoral artery

目的探讨双侧旋股外侧动脉降支穿支皮瓣组合移植修复下肢大面积软组织缺损的可行性与临床效果。方法自2014年1月至2019年9月,采用双侧旋股外侧动脉降支穿支皮瓣组合移植,一期修复下肢大面积软组织缺损35例。创面涉及小腿部17例、足踝部12例、小腿及足踝部6例;缺损面积17.0 cm×12.0 cm^33.0 cm×18.0 cm。创面经彻底清创后,设计双侧旋股外侧动脉降支穿支皮瓣组合移植修复,供区创面一期直接闭合。19例合并有胫骨开放性粉碎性骨折,则先行外固定支架固定骨折,创面采用VSD治疗5~7 d,伤情稳定后行皮瓣修复。皮瓣血液循环重建采用远端皮瓣的降支血管蒂串联于近端皮瓣的降支远端或降支的粗大分支血管。皮瓣携带股外侧皮神经,缝接于创面周缘、创面内的感觉神经。术后随访皮瓣的颜色、质地、感觉、继发溃疡及患肢功能。结果本组34例组合皮瓣完全成活,1例小腿和足部损伤严重,术后皮瓣坏死,最后截肢。皮瓣供区一期愈合,无并发症发生。随访6~38个月,平均17.6个月,皮瓣的颜色、质地均正常,感觉恢复S3~S4级,恢复正常行走功能。结论双侧旋股外侧动脉降支穿支皮瓣组合移植修复组织缺损面积大,手术安全可靠,供区损伤小,是一种修复下肢大面积软组织缺损的有效方法。

Objective To investigate the feasibility and clinical effect of combined transplantation of bilateral perforator flap based on the descending branch of lateral circumflex femoral artery in the reconstruction of large soft tissue defects of lower limbs.Methods From January,2014 to September,2019,35 cases of large soft tissue defects of lower limbs were repaired by combined transplantation of bilateral perforator flap based on the descending branch of lateral circumflex femoral artery,and the donor sites were directly closed.The wound involved the shank,ankle and foot;The areas of defect ranged from 17.0 cm×12.0 cm to 33.0 cm×18.0 cm.External fixation were performed on 19 cases with open comminuted tibia fracture,and flap transplantation was preformed after through debridement and negative-pressure wound therapy for 5-7 days.The lateral femoral cutaneous nerve was remained in the flap,which was anastomosed with sensory nerves in the recipient site.The colour,texture,sensation,secondary ulcer of the flap and limb function were followed-up after the operation.Results Of the 35 cases,34 cases completely survived,and necrosis occurred in 1 case.The donor sites were closed primarily and complication was not observed in any of the cases.The followed-up period ranged from 6 to 38 months,at 17.6 months in average.The appearance and function of the reconstructed lower limbs were satisfactory.Conclusion The combined transplantation of the perforate flap of descending branch of lateral femoral circumflex artery is safe and reliable.It can be used to repair large defect and the damage of the donor site is limited.It is an effective method to repair large area of soft tissue defects of lower limbs.