CT血管造影辅助下以旋股外侧动脉斜支血管为蒂的游离股前外侧穿支皮瓣修复四肢软组织缺损

Free anterolateral thigh perforator flap pedicled with the oblique branch of lateral circumflex femoral artery assisted by three-dimensional CT angiography for repairing soft tissue defects of limbs

目的探讨CT血管造影(CTA)辅助下,以旋股外侧动脉(LCFA)斜支血管为蒂的游离股前外侧穿支皮瓣修复四肢软组织缺损的临床疗效。方法采用回顾性病例对照研究分析2015年3月至2020年3月宁波市第六医院收治的51例四肢软组织缺损患者临床资料,其中男31例,女20例;年龄26〜63岁[(42.0±8.9)岁]。缺损部位:前臂15例,手部13例,小腿15例,足踝部8例。缺损面积为9 cm×6 cm~18 cm×lO cm,皮辨切取面积为10 cm×6 cm~20 cm ×l2 cm。33例术前行CTA+多普勒超声定位穿支血管(CTA组),18例术前仅应用多普勒超声定位(多普勒组)。所有患者丨期行清创、负压封闭引流(VSD),II期均行以LCFA斜支血管为蒂的游离股前外侧穿支皮瓣移植修复。记录CTA组术前穿支血管蒂管径及长度、两组术中穿支血管蒂管径及长度、皮瓣切取时间;术后1周观察两组皮瓣成活情况;末次随访时,采用张浩等制定的疗效满意度评分标准评价两组皮瓣修复的疗效。结果患者均获随访6~12个月[(9.1±1.5)个月]。CTA组术前LCFA斜支血管蒂管径与术中比较,差异无统计学意义(P>0.05),术前血管蒂长(12.3±2.1)cm,大于术中的(10.9±2.2)cm(P<0.05)。两组术中LCFA斜支血管蒂管径、长度差异均无统计学意义(P>0.05)。CTA组皮瓣切取时间为(38.5±6.2)min,显著短于多普勒组的(51.4±8.4)min(P<0.05)。术后1周两组皮瓣均成活,CAT组2例术后出现动脉危象,手术探查后1例成活,1例部分坏死,经换药后愈合;多普勒组1例出现动脉危象并部分坏死,经换药后愈合(P>0.05)。末次随访时,CTA组疗效满意度评分为(8.5±1.5)分,高于多普勒组的(7.4±2.0)分(P<0.05)。结论以LCFA斜支血管为蒂的游离股前外侧穿支皮瓣修复四肢软组织缺损,与多普勒超声检查相比,术前CTA检查可准确获取穿支血管解剖学信息,节省皮瓣切取时间,皮瓣修复的疗效更满意。

Objective To investigate the clinical effect of the anterolateral femoral perforator flap(ALTP)pedicled with the oblique branch of lateral circumflex femoral artery(LCFA)assisted by CT angiography(CTA)examination for repairing soft tissue defects of limbs.Methods A retrospective case series study was made on 51 patients with soft tissue defects of limbs treated in Ningbo No.6 Hospital from March 2015 to March 2020,including 31 males and 20 females at age of 26-63 years[(42.0±8.9)years].The defects were located al the forearm in 15 patients,at the hand in 13,at the lower leg in 15 and at the ankle in 8.The size of defects ranged from 9 cmX6 cm to 18 cmXlO cm,with the size of flaps from 10 cmX 6 cm to 20 cmX 12 cm.A total of 33 patients were examined with CTA scanning and Doppler ultrasound(CTA group)and 18 patients with Doppler ultrasound(Doppler group).All patients underwent debridement and negative pressure closed drainage(VSD)at stage I and were repaired by ALTP pedicled with the oblique branch of LCFA at stage II.The diameter and length of the vessel pedicle was recorded in CTA group before operationand in both groups during operation.The time of flap harvesting in both groups was recorded during operation.The survival of the flap in both groups was observed one week after operation.Zhang Hao’s scoring standard was applied to evaluate the outcome at the last follow-up.Results All patients were followed up for 6-12 months[(9.1±1.5)months].In CTA group,the diameter of LCFA vessel pedicle measured before operation had no significant difference from that during operation(P>0.05),while the length of LCFA vessel pedicle before operation[(12.3±2.1)cm]was longer than(10.9±2.2)cm during operation(P<0.05).The two group showed no significant differences in the diameter and length of LCFA vessel pedicle during operation(P>0.05).The time of flap harvesting in CTA group was(38.5±6.2)minutes,significantly shorter than(51.4±8.4)minutes in Doppler group(P<0.05).One week after operation,all flaps survived.Two patients developed flap arterial congestion in CTA group,among whom one survived after surgical revision and one with partially necrosis was healed after dressing change.One patient was found with flap arterial congestion with partial necrosis in Doppler group,who was healed after dressing change.There was no significant difference in postoperative flap arterial congestion between the two groups(P>0.05).The patients’satisfaction score in CTA group was(8.5±1.5)points at the last follow-up,higher than(7.4±2.0)points in Doppler group(P<0.05)•Conclusion For repairing soft tissue defects of limbs,free ALTP pedicled with the oblique branch of LCFA assisted by three-dimensional CT angiography can accurately get the information of perforator,shorten the flap harvesting time,and obtain satisfactory clinical results as compared to Doppler ultrasound.