Ⅲ型旋股外侧动脉斜支穿支皮瓣的血管解剖及临床应用

Vascular anatomy and clinical application of typeⅢperforator flap based on the oblique branch of lateral circumflex femoral artery

目的探讨Ⅲ型旋股外侧动脉斜支穿支皮瓣的血管解剖及该皮瓣游离移植修复四肢皮肤软组织缺损的疗效。方法对1具灌注红色乳胶的43岁男性尸体标本进行大腿股前外侧皮瓣的血管解剖,观察旋股外侧动脉斜支走行及穿支分布情况。采用回顾性病例系列研究分析2018年1月—2019年9月收治的12例四肢皮肤软组织缺损患者临床资料,其中男9例,女3例;年龄18~65岁,中位年龄32岁。损伤部位:足踝部7例,小腿3例,手部2例。创面范围为9 cm×7 cm~28 cm×10 cm。受伤至手术时间1~2周,平均10 d。均采用Ⅲ型游离旋股外侧动脉斜支穿支皮瓣修复,切取单叶皮瓣3例,双叶皮瓣6例,三叶皮瓣3例;皮瓣范围为15 cm×5 cm~28 cm×10 cm。供区直接缝合或采用局部皮瓣修复。术后观察皮瓣成活及并发症发生情况。结果血管解剖研究结果示,旋股外侧动脉发出横支、斜支和降支,斜支沿途发出多个肌穿支,穿支穿过股前外侧肌,供血范围为股前外侧区域皮肤。临床研究结果示,所有皮瓣完全成活,切口均Ⅰ期愈合;均无血管危象等并发症发生。12例患者均获随访,随访时间3~12个月,平均7个月。皮瓣外观、质地良好;末次随访时根据英国医学研究院(BMRC)神经外伤学会标准评价,皮瓣感觉恢复达S2级9例、S3级3例。供区残留线性瘢痕,无疼痛、瘙痒、触觉过敏等不适。患者及家属均满意。结论Ⅲ型旋股外侧动脉斜支穿支皮瓣血供可靠,切取面积大,可切取多种形式的穿支皮瓣,可修复四肢皮肤软组织缺损。

Objective To investigate the vascular anatomy and the clinical application of typeⅢperforator flap based on the oblique branch of lateral circumflex femoral artery on skin soft tissue defect at the limbs.Methods Vascular anatomy of anterolateral thigh flap was performed on a 43-year-old male cadaver perfused with red latex,and the travel and perforating distribution of the oblique branches of lateral circumflex femoral artery were observed.A retrospective case series study was used to analyze the clinical data of 12 patients with skin soft tissue defects of the extremities admitted between January 2018 and September 2019,including 9 males and 3 females;aged from 18 to 65 years,with a median age of 32 years.The injury site included 7 cases of foot and ankle,3 cases of calf,and 2 cases of hand.The wound size was ranged from 9 cm×7 cm to 28 cm×10 cm.The time from injury to operation was 1-2 weeks,with an average of 10 days.All patients were repaired with typeⅢperforator flap based on the oblique branch of lateral circumflex femoral artery,including 3 cases of single-leaf flap,6 cases of double-leaf flaps,and 3 cases of tri-leaf flaps.The flap ranged from 15 cm×5 cm to 28 cm×10 cm.The donor site was directly sutured or repaired with local flap.The flap survival and complications were observed after operation.Results The results of vascular anatomy showed that the lateral femoral circumflex artery sent out transverse branches,oblique branches,and descending branches.The oblique branches sent out multiple muscle perforating branches along the way,the perforating branches passed through the anterolateral femoral muscle,and the blood supply scope was the skin of the anterolateral femoral region.The clinical results showed that all flaps survived completely and the incisions healed by first intension.There was no complication such as vascular crisis.All12 patients were followed up 3-12 months,with an average of 7 months.The appearance and texture of the flap were good.At last follow-up,according to the British Medical Research Council(BMRC)Society for neurological trauma standard,the sensory of the flap reached S2 in 9 cases and S3 in 3 cases.Linear scar remained in the donor area,without pain,pruritus,tactile allergy,and other discomfort.The patients and their families were satisfied.Conclusion TypeⅢperforator flap based on the oblique branch of lateral circumflex femoral artery is a reliable method for repairing the soft tissue defect of the limbs,with reliable blood supply,large cutting area,various types of perforator flaps.