优化设计的游离股前外侧穿支皮瓣修复四肢复杂软组织缺损的临床观察

Clinical Observations of Optimized Designed Free Anterolateral Thigh Perforator Flaps for the Treatment of Complex Soft Tissue Defect of Limbs

目的观察经优化设计的游离股前外侧穿支皮瓣修复四肢复杂软组织缺损的临床疗效。方法回顾性分析2014年1月~2020年3月收治的43例四肢复杂软组织缺损患者的临床资料。缺损原因:车祸22例,重物压砸伤11例,机械绞伤6例,农机伤1例,轮辐伤2例,热压伤1例。损伤部位:下肢36例,上肢7例。股前外侧穿支皮瓣切取面积为(9 cm×6 cm)~(37 cm×8 cm)。将彻底清创的创面按缺损标准进行分类,根据重建需求(面积、深度、缺损的组织)对皮瓣进行优化设计。结果本组移植皮瓣全部成活36例,部分存活4例,坏死3例,皮瓣存活率为93.02%(40/43)。术后受区并发症:血管危象6例,感染6例,皮下积血3例,皮缘部分坏死4例。术后供区并发症:皮缘部分坏死1例,感染2例。皮瓣恢复情况评定:优秀31例,良好6例,一般3例,差3例,优良率86.05%(37/43)。结论优化设计的游离股前外侧穿支皮瓣是一种治疗四肢复杂皮肤软组织缺损的方法。

Objective To explore the clinical effects of optimized designed free thigh anterolateral perforator flaps for the treatment of complex soft tissue defect of limbs.Methods A retrospective analysis was performed on 43 patients admitted from January 2014 to March 2020.There were 22 cases of traffic accidents,11 of heavy weight injuries,6 of mechanical wounds,1 of agricultural machinery injury,2 of spoke injuries and 1 case of hot crush injury.36 cases located in the lower limbs and 7 cases in upper limbs.The excision of anterolateral thigh perforator flaps ranged from 6 cm×9 cm to 8 cm×37 cm.The debridement was classified according to the defect standards,and the flaps were optimized according to the reconstruction requirements(area,depth and tissue defect).Results Of the all 43 flaps,there were 36 survived completely,4 survived partially and 3 lost vitality.The survival rate of flaps was 93.02%(40/43).There were 19 cases of postoperative complications in the recipient site,including vascular crisis in 6 cases,infection in 6 cases,subcutaneous hematoma in 3 cases,and partial skin margin necrosis in 4 cases.There were 3 cases of postoperative complications in the donor site,including partial cutaneous necrosis in 1 case,and infection in 2 cases.Evaluation of flap recovery showed 31 cases of excellent,6 cases of good,3 cases of fine and 3 cases of poor.The good and excellent rate was 86.05%(37/43).Conclusion The optimal designed of free anterolateral thigh perforator flap is a method for the treatment of complicated skin and soft tissue defects in limbs.