以腓肠肌内侧头动脉供血的游离股前外侧皮瓣修复小腿复杂创面的临床研究

Clinical study on the repair of complex wounds in the lower leg using free lateral femoral flap with blood supply from the medial gastrocnemius artery

目的探讨以腓肠肌内侧头动脉为受区供血动脉的游离股前外侧皮瓣修复小腿复杂创面的手术方法及临床疗效。方法回顾性分析2020年10月—2022年9月苏州瑞华骨科医院收治的11例小腿复杂创面患者的临床资料。患者均存在小腿大面积皮肤及皮下软组织缺损,均接受游离对侧大腿股前外侧皮瓣修复,受区以腓肠肌内侧头动脉为供血动脉,供区皮肤直接缝合。结果11例患者11块游离皮瓣均成活,供区、受区创面均Ⅰ期愈合。出院后患者均获随访,随访时间12~35个月。术后12个月随访结果显示,所有患者创面愈合良好,皮瓣外观、弹性良好;所有患者恢复正常膝、踝关节功能,具有自主生活能力;供区伤口愈合良好,无明显瘢痕增生。末次随访时,皮瓣感觉功能评定为S 3级者2例、S 2级者9例;患肢功能评分达优者5例、良者6例,优良率高达100%。结论腓肠肌内侧头动脉血管口径适于吻合、位置恒定,以该动脉供血的游离股前外侧皮瓣修复小腿严重创面,可有效覆盖软组织缺损,并避免损伤小腿残留主干血管,疗效满意。

Objective To investigate the surgical method and clinical outcome using the free anterolateral thigh flap with the medial gastrocnemius artery as the recipient artery for the repair of complex wounds in the lower leg.Methods A retrospective analysis was conducted on the clinical data of 11 patients with complex wounds in the lower leg admitted to Suzhou Ruihua Orthopedic Hospital from October 2020 to September 2022.All patients had extensive skin and subcutaneous soft tissue defects in the lower leg and received free anterolateral thigh flap repair with the medial gastrocnemius artery as the recipient artery.The skin of donor site was directly sutured.Results All 11 free skin flap survived in 11 patients,and both the donor and recipient sites healed in stage I.All patients were followed up after discharge,with a follow-up time of 12 to 35 months.The follow-up results at 12 months postoperatively showed good wound healing,good flap appearance and elasticity,restoration of normal knee and ankle joint function,and independent living ability.The donor site wounds healed well without significant scar hyperplasia.At the last follow-up,the flap sensory function was graded as S 3 in 2 patients and S 2 in 9 patients.The functional score of the affected limb was excellent in 5 patients and good in 6 patients,with an excellent and good rate of 100%.Conclusion The medial gastrocnemius artery has a suitable vessel caliber for anastomosis and a constant location.The use of the free anterolateral thigh flap with this artery as the recipient artery for the repair of severe wounds in the lower leg can effectively cover soft tissue defects and avoid injuring the residual main vessels in the lower leg,resulting in satisfactory outcomes.