游离股前外侧筋膜瓣和皮瓣治疗手足软组织创伤疗效对比

Free Transplantation of Anterolateral Femoral Fascial Flaps Versus That of Anterolateral Femoral Skin Flap in Treating Hand and Foot Soft-tissue Trauma: A Comparative Analysis

目的比较游离股前外侧筋膜瓣和皮瓣修复手足软组织损伤的综合疗效。方法整群选取2006年6月—2011年12月收治的手足软组织缺损患者62例,观察组32例,行游离股前外侧筋膜瓣改良植皮修复术;对照组30例,行股前外侧皮瓣游离移植术;观察成活率与并发症,随访6~18个月。结果观察组筋膜瓣完全成活,外观、质地良好,创面Ⅰ期愈合,感觉正常;对照组8例静脉危象,经拆线减张、罂粟碱解痉后缓解,创面Ⅱ期愈合,其余皮瓣完全成活,外观臃肿,触感麻木。观察组创面Ⅰ期愈合率明显高于对照组(100%VS 73.3%,χ2=9.798,P=0.002),差异有统计学意义(P<0.05)。结论游离股前外侧筋膜瓣治疗手足软组织损伤疗效显著优于股前外侧皮瓣修复术。

Objective To compare the overall efficiency of free transplantation of anterolateral femoral fascial flaps with that of anterolateral femoral skin flap in treating hand and foot soft-tissue trauma. Methods 62 patients with hand and foot soft-tissue injury admitted from June 2006 to December 2011 were included. The 32 patients who were assigned to the observation group underwent modified free transplantation of anterolateral femoral fascial flaps, while the 30 patients who were assigned to the control group were treated with free transplantation of anterolateral femoral skin flap. All the patients were followed up 6-18 months to observe the survival rate and complications. Results In the observation group, fascial flap survived completely and showed satisfying appearance and quality, and all incisions healed by first intention without abnormal sensation; in the control group, 8 patients were found with vein crisis and it was eased after stitch removal and tension relaxing and spasmolysis by papaverine, and their incisions healed by second intention, while the flaps of other patients survived completely with bloated appearance and numbness when be touched. The rate of healing by first intention was higher in the observation group than in the control group(100% vs 73.3%, χ2=9.798,P=0.002), and the difference was statistically significant(P<0.05). Conclusion Free transplantation of anterolateral femoral fascial flaps is superior to that of anterolateral femoral skin flap in treating hand and foot soft-tissue trauma.