以筋膜蒂相连的单穿支双叶型股前外侧皮瓣修复四肢创面的临床研究

Repair of extremity wounds with single-leaf perforated anterolateral thigh bilobed flaps connected by fascial pedicle.

目的探讨以筋膜蒂相连的单穿支双叶游离型股前外侧皮瓣修复肢体创面的临床效果。方法自2013年8月至2019年9月,使用以筋膜蒂相连的单穿支双叶型股前外侧皮瓣修复四肢创面24例,其中18例为单个创面,面积14 cm×7 cm~24 cm×14 cm;5例为手或足的两处创面,面积4 cm×4 cm~30 cm×17 cm;1例为左2~5指背侧远端创面,作为两个创面来处理。所有病例设计以筋膜蒂相连的单穿支双叶型皮瓣修复,供区直接缝合。结果本组双叶皮瓣均顺利成活,大腿供区均Ⅰ期愈合。随访4~70个月,皮瓣色泽质地良好,皮瓣温、痛、触觉部分恢复。供区均存留线性瘢痕,1例瘢痕面积较大,但未出现瘢痕挛缩及疼痛等不适,2例患者术后早期出现切口区感觉异常,3月后恢复,无其他严重并发症发生。结论应用以筋膜蒂相连的单穿支双叶型股前外侧皮瓣修复四肢创面,可以解决穿支数量不足致双叶皮瓣无法切取的问题,同时减小供区切取宽度,有效地降低损伤。

Objective To explore the clinical effect of repairing limb wounds by single-leaf perforated anterolateral thigh bilobed flaps connected by fascial pedicle.Methods Twenty-four cases of limb wounds were repaired with fascial pedicled bilobed anterolateral thigh perforator flaps in our hospital from August 2013 to September 2019,of which 18 cases were single wounds with wound area from 14cm×7cm to 24 cm×14 cm.Five cases had two contiguous wounds on the hand or foot,with the wound area ranging from 4 cm×4 cm to 30 cm×17 cm.One patient’s wounds located on the distal dorsal side of the left 2-5 fingers,which were also treated as two wounds.In all cases,single-leaf perforated anterolateral thigh bilobed flaps connected by fascial pedicle were designed for repairing.And the donor areas were sutured directly.Results All the bilaterally lobed flaps survived successfully and all the donor areas of thigh healed in stage I.All the patients were followed-up for 4 to 70 months,which showed that all the flaps were of good color and texture,and the sensation of the flaps recovered partially.Linear scars were remained in all donor sites.One case had a large scar area without any scar contracture,pain or other discomfort.Two cases had paresthesia in the incision area in the early postoperative period,which gradually recovered 3 months later without any other serious complications.Conclusions The application of single-leaf perforated anterolateral thigh bilobed flaps connected by fascial pedicle can solve the problem that the bilobed flap cannot be cut because of perforator variations,and reduce the width of the donor area at the same time,which effectively reducing the injury.