健侧供血Flow-through串联双股前外侧皮瓣修复下肢超大面积软组织缺损

Double flow-through anterolateral thigh flaps based on blood supply from the healthy side in reconstruction of large soft tissue defects of lower limbs

目的探讨健侧供血Flow-through串联双股前外侧皮瓣修复下肢严重创伤后超大面积软组织缺损的方法及治疗效果。方法选取2009年1月—2019年12月西京医院骨科显微组治疗下肢严重损伤患者3例,其中男性2例,女性1例,均为小腿大面积软组织及主干血管损伤,缺损范围:26 cm×15 cm~31 cm×20 cm。采用股前外游离皮瓣联合健侧小腿桥式交腿皮瓣修复。结果术后3例皮瓣全部存活,未发生血管危象、皮瓣坏死、感染、骨髓炎等严重并发症。术后随访12~24个月,平均18个月,患肢皮肤及外观正常,功能恢复满意。结论对于伴有广泛软组织及主干血管损伤的小腿严重损伤,采用健侧供血的Flow-through串联双股前外侧皮瓣具有血运充分、为广泛软组织缺损提供单一皮瓣所达不到的有效覆盖、皮瓣存活率高等优势,该技术的应用对于提升下肢严重创伤的保肢治疗以及创面修复意义重大。

Objective To investigate the method and therapeutic effect of the double flow-through anterolateral thigh flaps based on blood supply from the healthy side in reconstruction of large soft tissue defects of lower limbs after severe trauma.Methods From January 2009 to December 2019,three patients(2 male and 1 female subjects)with severe lower limb injury were treated by the orthopaedic microsurgery group of Xijing Hospital.All of them were suffered from large-area soft tissue and main blood vessel injury of lower limb,with a defect range of 26 cm×15 cm~31 cm×20 cm.Double flow-through anterolateral thigh flaps based on blood supply from the healthy side was applied for all 3 patients.Results Patients were followed up for 12~24 months(mean 18 months).All the flaps survived without vascular crisis,necrosis,infection and osteomyelitis.The skin and appearance of the flaps were normal and functional recovery was satisfactory.Conclusion For lower limbs with extensive soft tissue and main blood vessel injuries,the double flow-through anterolateral thigh flaps based on blood supply from the healthy side have advantages such as sufficient blood supply,effective coverage for extensive soft tissue defects that cannot be achieved by a single flap,and high survival rate.The application of this technique is of great significance for improving the limb salvage and wound repairing of severe lower limb trauma.