带神经股前外穿支削薄皮瓣修复足踝大面积创面

Free thinned sensate anterolateral thigh perforator flap for repair of large tissue defect on the foot and ankle

[目的]介绍采用带神经股前外穿支削薄皮瓣修复足踝大面积创面的手术技术与初步临床效果。[方法]对9例足踝大面积创面患者行带神经股前外穿支削薄皮瓣修复。术前用彩超辅助血管、神经定位。先切开皮瓣内侧,解剖股外侧皮神经和穿支血管,切开外侧缘完成游离,修剪脂肪至皮瓣厚5~8 mm。将游离皮瓣覆盖足部创面,吻合血管、神经。[结果] 9例患者皮瓣均存活,随访10~60个月。末次随访时,皮瓣单丝触觉辨别次数和钝锐痛觉辨别次数较健侧低(P<0.05);但皮瓣中心部位的触觉和钝锐痛觉恢复显著优于周边区域(P<0.05),供区温哥华瘢痕评分为(4.78±1.48)分。[结论]用带神经股前外穿支削薄皮瓣修复足踝大面积创面术后皮瓣感觉恢复较充分,大小与对侧较匹配;患足可穿普通鞋无痛行走;供区副损伤较轻。

[Objective] To introduce the surgical technique and primary clinical outcomes of free thinned sensate anterolateral thigh perforator flap for repair of large tissue defect on the foot and ankle. [Methods] A total of 9 patients received free thinned sensate anterolateral thigh perforator flap for repair of large tissue defect on the foot and ankle. Color ultrasound was conducted to localize the vascular vessels and nerves before surgery. During harvesting the graft, the proximal side of the flap was cut firstly, and then the lateral femoral cutaneous nerve and perforating vessels were dissected, finally the distal edge was cut to complete dissociation, Subsequently, the fat tissue was trimmed until the thickness of the flap achieved 5~8 mm. The free flap was covered wound on foot and ankle, and anastomose the blood vessels and nerves. [Results] All the 9 patients had the flap survived and were followed up for 10~60 months. At the last follow-up, the number of mono-filar tactile discrimination and blunt acute pain discrimination was lower than that of the healthy side(P<0.05). However, the recovery of tactile sensation and acute pain sensation in the central part of the flap was significantly better than that in the surrounding area(P< 0.05). The Vancouver scar score in the donor area was of(4.78±1.48). [Conclusion] The free thinned sensate anterolateral thigh perforator flap for repair of large tissue defect on the foot and ankle has advantages of relatively moderate donor side morbidity, sufficient sensory recovery of the skin, proper size of recipient foot matching with the opposite side to permit the painless walking with ordinary shoes wearing.