分叶股前外侧穿支皮瓣修复四肢软组织缺损

Reconstruction of soft tissue defects of extremities with polyfoliate anterolateral thigh perforator flap

目的报道应用分叶股前外侧穿支皮瓣(ALTPF)修复四肢软组织缺损的临床效果。方法 2017年4月至2020年1月,应用分叶ALTPF修复四肢软组织缺损21例,其中11例车祸外伤,8例机器碾压伤,2例医源性并发症。小腿部及足踝部14例,手部及腕部7例。创面面积17.0 cm×12.0 cm~20.0 cm×14.0 cm,其中8例合并骨折、骨外露,13例合并肌腱、神经外露。13例为两个相邻的创面,8例为一个宽大创面。设计分叶ALTPF进行创面修复。术后定期随访,末次随访内容包括皮瓣的色泽、质地、外形、感觉及供区瘢痕情况进行记录。结果术后21例患者受区均未出现感染,所有皮瓣成活。本组2例出现静脉危象,1例术后5 h出现静脉危象,急诊探查发现吻合的2条静脉均出现血栓,经过取栓后再次吻合皮瓣完全成活;另1例术后2 h出现一叶皮瓣静脉危象。急诊探查发现皮瓣内侧缘回流至大隐静脉的浅静脉与受区浅静脉吻合口栓塞,经过取栓后再次吻合,皮瓣成活。所有供区创面均一期愈合。随访6~30个月,平均12.3个月,所有皮瓣色泽、质地良好,外形轻度臃肿,感觉迟钝,供区仅有线形瘢痕,外观评价良好。结论分叶ALTPF可一期修复较大或邻近的两个创面,最大程度减少供区的损害,是一种修复四肢宽大或邻近两个创面的理想方法。

Objective To report the clinical effect of using polyfoliate anterolateral thigh perforator flap(ALTPF)in reconstruction of soft tissue defects of extremities.Methods From April 2017 to January 2020,21 cases of soft tissue defect in extremities were repaired by polyfoliate ALTPF,including 11 cases of traffic accident trauma,8 of machine crush injury,and 2 of iatrogenic complications.There were 14 cases in calf and ankle,and 7 in hand and wrist.The area of defect was 17.0 cm×12.0 cm-20.0 cm×14.0 cm.Eight cases were complicated with fracture and bone exposure,13 with tendon and nerve exposure.Thirteen cases had 2 adjacent wounds and 8 had large wound.The polyfoliate ALTPF was designed for wound repair.The patients entered follow-up regularly.The last follow-up included the colour,texture,shape,sensation of the flap and the scar of the donor area.Results There was no infection in the recipient site of all 21 patients after operation,and all flaps survived.Two cases had venous crisis,with 1 was found in 5 hours after operation.Emergency exploration found that there were thrombosis in anastomosed veins.The flap survived completely after the thrombus removed and the embolized vein was anastomosed again.Another case was found with venous crisis at 1 lobe of flap in 2 hours after operation.Emergency exploration found that the anastomotic site between the superficial vein from the medial edge of the flap to the great saphenous vein and the superficial vein of the recipient area was embolised.The flap survived completely after the thrombus removed and the embolized veins was anastomosed again.The wounds of all donor sites healed in the first stage.All patients were followed-up for 6-30(mean 12.3)months.All flaps had good colour and texture,with slightly bloated appearance and dull sensation.There was only a linear scar in the donor area,and the appearance evaluation was good.Conclusion Polyfoliate ALTPF can be used to repair 2 large or adjacent wounds in 1 stage,reduce the damage of donor site.It is an ideal method to repair large or adjacent wounds of limb.