血管增压和超回流技术在游离股前外侧皮瓣中的临床应用

Vascular pressurisation and super-reflux techniques applied in free anterolateral thigh flap

目的探讨血管增压和超回流技术在游离股前外侧皮瓣(ALTF)中的临床应用疗效。方法2017年1月至2021年9月,海南医学院第二附属医院手足显微外科收治四肢软组织缺损31例,男23例,女8例,年龄4~76岁,平均40岁,均切取携带旋股外侧动脉(LCFA)降支与斜支两组血管的游离ALTF进行移植并应用血管增压和超回流技术进行创面修复。软组织缺损面积7 cm×5 cm~22 cm×10 cm,皮瓣切取面积8 cm×6 cm~23 cm×11 cm,供区直接缝合。采用皮瓣内增压(或超回流)术式15例,采用皮瓣外增压(或超回流)术式16例。术后经门诊、电话、微信或上门定期随访,评估创面修复术后疗效。结果本组31例皮瓣全部成活,其中2例皮瓣术后创口轻度感染,予拆线换药处理,术后供区及受区创面均完全愈合。术后随访3~55个月,受区皮肤质地、色泽、外观良好,皮瓣TPD为7~12 mm。结论血管增压和超回流技术在游离ALTF修复四肢软组织缺损的临床应用中,疗效稳定、可靠。

ObjectiveTo investigate the clinical effect of vascular pressurisation and super reflux on free anterolateral thigh flap(ALTF).MethodsFrom January 2017 to September 2021,the Department of Hand and Foot Microsurgery,the Second Affiliated Hospital of Hainan Medical College had treated 31 cases of soft tissue defects of the limbs.The patients were 23 males and 8 females,aged 4-76 years old at 40 years old in average.All the patients received transfer of free ALTFs carrying 2 groups of blood vessels of the descending and oblique branches of lateral circumflex femoral artery(LCFA).The vascular pressurisation and super-reflux techniques were applied in wound repair.Soft tissue defect area 7 cm×5 cm-22 cm×10 cm.The sizes of flaps were 8 cm×6 cm-23 cm×11 cm.All the donor sites were sutured directly.Fifteen patients had inner flap pressurisation(or super-reflux)and the rest of 16 patients had external flap pressurisation(or super-reflux).After surgery,scheduled follow-ups were conducted through outpatient clinic,telephone and WeChat reviews or home visits to evaluate the efficacy of wound repair.ResultsAll the 31 flaps survived,except 2 flaps that had mild infection after surgery.The wounds of donor and recipient sites healed completely.The time of follow-up was 3-55 months.The skin of flaps achieved good texture,colour,lustre and appearance.TPD of the flaps ranged 7-12 mm.ConclusionVascular pressurisation and super reflux technique are stable and reliable in the clinical application of free ALTF to repair soft tissue defects of limbs.