不带阔筋膜的股前外侧皮瓣移植在小儿轮辐伤致足踝皮肤缺损修复中的应用

Application of anterolateral thigh perforator flap without fascia lata in treatment of skin defect of foot and ankle caused by spoke hurt in children

目的探讨应用不带阔筋膜的股前外侧皮瓣移植修复小儿轮辐伤致足踝皮肤缺损的临床效果。方法对2013年5月至2016年10月山东省烟台市烟台山医院手外一科采用不带阔筋膜的股前外侧皮瓣移植治疗的轮辐伤致足踝皮肤缺损患儿6例的临床资料进行回顾性分析。其中男3例,女3例,平均年龄6(4~12)岁;均为电瓶车或摩托车轮辐伤;皮肤缺损部位足背4例,足跟2例;皮瓣面积4 cm×10 cm~15 cm×8 cm。全部患儿在接受一期手术行创面清创、骨折固定、肌腱修复、负压封闭引流(VSD),待创面稳定且无异常分泌物之后,二期行超薄游离股前外侧皮瓣移植修复。术后平均随访时间为16(6~22)个月。观察受区创面皮瓣外观与质地;采用中华医学会肢体功能评定试用标准对下肢功能进行评价。结果二期修复手术平均用时4(3~5)h,术中平均出血量为75(60~100)ml。6例皮瓣均顺利成活,无血管危象发生;皮瓣血运良好,质地薄而柔软,无臃肿,外形满意,无需二次手术整形;下肢皮肤未见明显瘢痕挛缩及色素沉着,恢复深浅感觉;邻近关节屈伸活动无明显受限,下肢功能均为优。结论应用不带阔筋膜的股前外侧皮瓣移植修复小儿轮辐伤致足踝皮肤缺损,可获得良好的临床效果。

Objective To investigate the clinical effect of anterolateral thigh perforator flap without fascia lata in repair of skin defect of foot and ankle caused by spoke hurt in children.Methods Data of 6 cases with skin defect of foot and ankle caused by spoke hurt repaired by anterolateral thigh flap without fascia lata in the Department of Hand Surgery,Yantaishan Mountain Hospital from May 2013 to October 2016 were analyzed retrospectively.There were 3 males and 3 females with mean age of 6(4-12)years.Of all the cases,4 had skin defect of dorsal foot and 2 had skin defect of heel.The flap area was 4 cm×10 cm-15 cm×8 cm.All cases underwent secondary repair using anterolateral thigh perforator flap without fascia lata after primary debridement,fracture fixation and tendon repair.Follow-up of 16(6-22)months was completed.Appearance of the flaps were observed.Functional rehabilitation of the lower limbs were evaluated using Chinese Medical Association limb function evaluation trial standard.Results The mean operation time was 4(3-5)h.The mean blood loss was 75(60-100)ml.All the flaps survived successfully without vascular crisis.The flaps had good blood supply and were with thin and soft texture,no bulkiness,satisfactory appearance.None plastic surgery required.No obvious scar and pigmentation on the skin were found.Function of the lower limbs of all the cases were excellent.Conclusion Application of anterolateral thigh perforator flap without fascia lata in treatment of skin defect of foot and ankle caused by spoke hurt in children can achieve satisfactory clinical results.