游离股前外侧穿支嵌合阔筋膜瓣修复手腕部及足踝部复合组织缺损

Free anterolateral thigh perforator flap combined with fascia lata flap to repair dorsal of hand and wrist、ankle and foot tissue defect

目的探讨游离股前外侧穿支嵌合阔筋膜瓣修复手腕部及足踝部复合组织缺损的临床效果。方法回顾性分析采用游离股前外侧穿支嵌合阔筋膜瓣修复手腕部及足踝部复合组织缺损21例,观察其成活率、外形和术后功能,评价应用该嵌合皮瓣修复手腕部及足踝部复合组织缺损的临床应用价值。结果 1例皮瓣于术后15 h发生静脉血管危象,经过探查后顺利成活,其他所有皮瓣一期均顺利成活。供受区创面均一期愈合,术后随访时间6～18个月,平均(11. 47±3. 30)个月。皮瓣色泽、质地良好,皮瓣有不同程度臃肿,有9例患者二期行皮瓣修薄术。按中华医学会手外科学会上肢功能评定标准,优14例,良7例。结论游离股前外侧穿支嵌合阔筋膜瓣是一期修复手腕部及足踝部复合组织缺损的一种较为理想的方法。

Objective To investigate the clinical effect of free anterolateral thigh perforator flap with fascia lata flap in repairing composite tissue defect at dorsal of hand and wrist,ankle and foot. Methods Retrospective analysis of the free anterolateral thigh perforator flap with fascia lata flap to repair the hands and feet back composite tissue defects was 21 cases. The survival rate,postoperative function,shape were observed and the clinical value of the chimeric flap in repairing the complex tissue defect of the hand and wrist,ankle and foot were evaluated. Results A patient with venous vascular crisis occurred 15 hours after the operation of the skin flap. All other flaps were successfully survived. The wounds in the donor site healed at stage I. The postoperative follow-up time was 6 to 18 months,average( 11. 47 ± 3. 30) months. The flaps color and texture were good. The flaps area were bloated in different degrees. There were 9 cases in two stages of flap thinned. According to the evaluation standard of upper limb function of Chinese society of hand surgery,there were 14 excellent cases and 7 good cases. Conclusion The free anterolateral thigh perforator flap with fascia lata flap is an ideal method for the repair of complex tissue defect at hand and wrist,ankle and foot.