带阔筋膜的股前外侧穿支皮瓣修复合并伸肌腱缺损的手足创面

Clinical application of the efficacy and feasibility of composite anterolateral thigh perforator-fascia lata flap for reconstruction complex tissue defect of hand and foot

目的探讨带阔筋膜的股前外侧穿支皮瓣修复合并伸肌腱缺损的手足创面的临床疗效及可行性。方法回顾性分析2014年5月至2019年12月深圳市龙岗区骨科医院应用带阔筋膜的股前外侧穿支皮瓣移植修复合并伸肌腱缺损的手足创面的患者资料。术中应用阔筋膜修复伸肌腱缺损,采用"8"字缝合法缝合阔筋膜与缺损伸肌腱的近、远端残端。股前外侧穿支皮瓣修复手足创面软组织缺损。供区采用拉拢缝合加游离皮片移植术修复。术后根据英国医学研究会制定的周围神经损伤后感觉功能评定标准评价皮瓣感觉恢复情况;根据中华医学会手外科学会手部肌腱修复后评定标准推荐的手指总主动活动度(TAM)系统评价手部运动功能;根据美国足踝外科医师协会制定并推荐的踝-后足评分系统评价足部运动功能。结果共纳入23例患者,男19例,女4例,年龄9~61岁,平均26岁。致伤原因:机器挤压伤11例,交通事故伤4例,重物压砸伤6例,电锯锯伤2例。创面缺损面积范围为2 cm×6 cm~7 cm×25 cm,肌腱缺损长度为1.0~10.0 cm。所有病例均合并伸肌腱部分或完全缺损,合并骨折、骨质缺损者7例,合并神经损伤者19例。患者均顺利完成修复,术后皮瓣均成活良好,皮瓣切取范围3 cm×5 cm~9 cm×23 cm,阔筋膜切取范围为1.0 cm×1.5 cm~4.5 cm×11.0 cm,未出现动静脉危象、感染、脂肪液化等并发症,创面均一期闭合。术后随访3~36个月,平均14个月,所有皮瓣外观均良好,颜色、质地佳。感觉恢复情况:优19例,良4例。采用TAM系统评价法及踝-后足评分系统评价手足功能情况:优21例,良2例。结论应用带阔筋膜的股前外侧穿支皮瓣修复合并伸肌腱缺损的手足创面能够在覆盖创面的同时恢复患肢运动及感觉功能。该方法对供区损伤小,术后并发症少,能够明显改善患者生活质量,是修复手足合并伸肌腱缺损创面的有效方法。

Objective To investigate the clinical efficacy and feasibility of anterolateral thigh perforator flap with fascia lata in repairing hand and foot wounds complicated with extensor tendon defect.Methods The clinical data of patients with hand and foot wounds complicated with extensor tendon defect who were repaired with anterolateral thigh perforator flap with fascia lata in Long Gang District Orthopedic Hospital of Shenzhen from May 2014 to December 2019 were analyzed retrospectively.During the operation,fascia lata was used to repair the defect of extensor tendon.The proximal and distal endof fascia lata were anastomosis with defect extensor tendon by figure 8 sutures.The soft tissue defects of hand and foot were repaired with anterolateral thigh(ALT)perforator flap.The donor site was closed primarily or covered by free skin graft.After operation,the sensory recovery of the flap was evaluated according to the evaluation standard of sensory function after peripheral nerve injury formulated by British Medical Research Association.According to the total active range of movement(TAM)of fingers recommended by the evaluation standard of hand tendon repair of Hand Surgery Society of Chinese Medical Association,the hand motor function was evaluated systematically.Foot motor function was evaluated according to the ankle-hind foot scoring system developed and recommended by the American Association of Foot and Ankle Surgeons.Results A total of 23 patients were enrolled,including 19 males and 4 females,aged from 9 to 61 years old,with an average age of 26 years old.Causes of injury:there were 11 cases of crushinjury associated with machine,4 cases of road traffic injury,6 cases of injury by falling heavy object,2 cases of saw injury.The area of wound defect ranged from 2 cm×6 cm to 7 cm×25 cm,and the length of tendon defect ranged from 1.0 cm to 10.0 cm.All cases were complicated with partial or complete defect of extensor tendon.There were 19 cases with fracture and nerve injury.All the injuries were successfully repaired.All the flaps survived well.The rande of flap harvest was 3 cm×5 cm to 9 cm×23 cm,and the fascia lata was 1.0 cm×1.5 cm to 4.5 cm×11.0 cm.There were no complications such as arteriovenous crisis,infection,fat liquefaction,etc.Andall the wounds were closed primarily.Follow-up period ranged from 3 to 36 months(average 14 months)showed that all flaps had aestheticappearance,good color,and texture.Sensory recovery:excellent in 19 cases and good in 4 cases.TAM system evaluation method and ankle-hind foot scoring system were used to evaluate the function of hand and foot:21 cases were excellent and 2 cases were good.Conclusions The application of anterolateral thigh perforator flap with fascia lata to repair the hand and foot wound with extensor tendon defect can restore the motor and sensory function of the injured limb while covering the wound surface.This method has less damage to the donor site and less postoperative complications,and can significantly improve the quality of life of patients.It is an effective method to repair the wounds of hand and footcombined with extensor tendon defect.