以股内侧穿支为血供来源的股前外侧区皮瓣修复四肢创面的疗效

Clinical effects of anterolateral thigh flap with blood supply source of medial femoral perforator in repairing the wounds on extremities

目的探讨应用以股内侧穿支为血供来源的股前外侧区皮瓣修复四肢创面的手术方法及临床疗效。方法采用回顾性观察性研究方法。2018年10月—2021年6月,苏州瑞华骨科医院收治12例符合入选标准的在行股前外侧皮瓣切取中未见旋股外侧动脉穿支或因穿支细小改用以股内侧穿支为血供来源进行皮瓣移植修复创面的患者(男11例、女1例,年龄24~64岁),创面位于上肢者7例、位于下肢者5例。清创后的创面面积为8.0 cm×5.0 cm~24.0 cm×6.5 cm,应用的皮瓣面积为9 cm×6 cm~25 cm×7 cm。移植皮瓣时,将皮瓣内穿支或源动脉与受区血管蒂行端端吻合。对供区创面均行皮下减张美容缝合。术后,观察皮瓣成活情况、有无血管危象以及供区创面愈合情况。随访时,观察皮瓣质地、供区创面并发症情况。末次随访时,采用自制改良皮瓣综合疗效评分表评价皮瓣修复效果。结果术后,患者皮瓣均成活,未发生血管危象;供区创面均顺利愈合。随访6~26个月,皮瓣质地优良;供区创面仅遗留线性瘢痕,无瘢痕挛缩或疼痛等不适。末次随访时,12例患者皮瓣修复效果的总得分为75~95分,平均为87分,其中评定为优者5例、良者6例、可者1例,优良患者占比为11/12。结论应用以股内侧穿支为血供来源的股前外侧区皮瓣修复四肢创面,是股前外侧皮瓣切取过程中遇到无旋股外侧动脉降支、斜支或穿支细小等变异情况的一种替代方法。该手术具有操作简单、创伤小等优点,有效保障了手术的顺利进行。

Objective To investigate clinical effects of anterolateral thigh flap with blood supply source of medial femoral perforator in repairing the wounds on extremities.Methods A retrospective observational study was conducted.From October 2018 to June 2021,Suzhou Ruihua Orthopedic Hospital admitted 12 patients(11 males and 1 female,aged 24-64 years)who met the inclusion criteria,and did not have the lateral circumflex femoral artery during anterolateral thigh flap resection,or changed to medial femoral perforator as a source of blood supply due to small perforator to repair the wound with flap transplantation.The wounds were on the upper limbs in 7 cases and on the lower limbs in 5 cases.The wound area after debridement was 8.0 cm×5.0 cm-24.0 cm×6.5 cm,and the applied flap area was 9 cm×6 cm-25 cm×7 cm.During transplantation,the perforating branch or source artery of the flap was anastomosed end to end with the vascular pedicle of the recipient area.Subcutaneous beauty suture was performed on all the donor wounds.After operation,the survival of the flap and vascular crisis were observed;and the wound healing at the donor site was observed.During follow-up,the texture of the flap and complications at the donor site were observed.At the last follow-up,the effect of flap repair was evaluated by using the modified self-made comprehensive efficacy rating table.Results After operation,all the flaps of patients survived without vascular crisis;the wounds in the donor site healed smoothly.During follow-up of 6 to 26 months,the flaps had good texture;only linear scars remained in the donor area without scar contracture,pain or other discomfort.At the last follow-up,the total score of flap repair effect of 12 patients was 75-95,with an average of 87,of which 5 cases were rated as excellent,6 cases as good,and 1 case as fair,and the proportion of excellent and good patients was 11/12.Conclusions The application of anterolateral thigh flap with blood supply from the medial femoral perforator to repair wounds on extremities is an alternative method for the vascular variations such as no descending branch,oblique branch,or small perforator of the lateral circumflex femoral artery during the resection of the anterolateral thigh flap.This operation has the advantages of simple operation,small trauma,and others,which effectively ensures the smooth operation.