旋股外侧动脉降支单穿支分叶皮瓣的临床应用

Clinical application of polyfoliate anterolateral thigh perforator flap with single-perforator

目的:旋股外侧动脉降支分叶皮瓣需要解剖共I级源血管的2个或多个穿支,是修复宽大而不规则创面的理想选择,然而穿支血管的不确定性制约了该术式的开展,本研究探讨旋股外侧动脉降支单穿支分叶皮瓣的可行性与临床疗效。方法:应用旋股外侧动脉降支分叶皮瓣治疗四肢皮肤软组织缺损,其中15例患者仅存在单穿支。根据术中探测结果设计单穿支分叶皮瓣,其穿支穿出点位于分叶皮瓣交界线附近。按“逆行四面解剖法”常规游离穿支血管和I级源血管后,在显微镜辅助下,在浅筋膜层内游离亚穿支血管,达到合适自由度后,将皮瓣进行分割并重新组合拼接,确认单穿支分叶皮瓣血运良好后断蒂并移植至受区。结果:15例旋股外侧动脉降支单穿支分叶皮瓣面积8.0 cm×5.0 cm+6.0 cm×5.5 cm~16.0 cm×9.5 cm+24.0 cm×9.0 cm;术后皮瓣存活良好,未发生皮瓣缺血坏死,外形满意,供区实现一期闭合。术后随访3~12(平均6)个月。皮瓣色泽正常,质地良好。结论:旋股外侧动脉降支单穿支分叶皮瓣只需解剖一个穿支、吻合一组血管、牺牲一个供区,是修复四肢宽大而不规则创面和解决股前外侧体区穿支血管不确定性的有效方法之一。

Objective:The polyfoliate anterolateral thigh perforator flap needs to dissect two or more perforators,which is an ideal choice for repairing wide and irregular wounds.However,the uncertainty of perforating vessels restricts the development of this operation.This study discusses the feasibility and clinical efficacy of the polyfoliate anterolateral thigh perforator flap with single-perforator.Methods:Fifteen patients with skin and soft tissue defects in extremities,were treated with polyfoliate anterolateral thigh perforator flap with single-perforator.Based on the perforator detected by Doppler ultrasound or color Doppler ultrasonography before operation,a polyfoliate anterolateral thigh perforator flap with single-perforator was designed.The perforating point of perforator was near the boundary of the skin paddle.Following the perforating vessels and vascular pedicles free,the vessels in the deep layer of the superficial fascia were meticulously free under the microscope.After obtaining the appropriate length,the skinpaddles were separated and recombined.After confirming the blood supply of flap,the vascular pedicle was ligated and transplanted to the recipient area.Results:In 15 cases,the area of the flap was 8.0 cm×5.0 cm+6.0 cm×5.5 cm to 16.0 cm×9.5 cm+24.0 cm×9.0 cm.All flaps survived well without necrosis and had a satisfactory appearance.The donor area was closed directly.The patients were followed up for 3 to 12 months,with an average of 6 months.The skin flaps were normal in color and good in texture.Conclusion:It's a better method to repair the skin and soft tissue defects in extremities by the polyfoliate anterolateral thigh perforator flap with single-perforator because only one perforator needs to be dissected,a group of blood vessels need to be anastomosed,and only one donor area needs to be sacrificed.