以股后皮神经营养血管为蒂的岛状皮瓣的临床应用

Clinical applications of the postfemur island flap pedicled with the postfemur neurocutaneous nutrient vessel

目的 探讨以股后皮神经营养血管为蒂的岛状皮瓣修复手术的应用。方法 采用以股后皮神经营养血管为蒂的岛状皮瓣修复臀部、窝及股内、外侧创面共 11例 12个创面 ,皮瓣最大面积 8 3cm× 16 6cm ,最小面积 4 0cm× 7 8cm。结果 11例 12个创面中 ,9个创面皮瓣完全成活 ,创面一期愈合 ,3个因静脉回流障碍 ,皮瓣远端出现皮肤坏死 ,但皮下成活 ,经皮片移植后创面愈合 ,随访 8～ 19个月不等 ,皮瓣质地、外观及功能满意。结论 这一皮瓣的动脉血供可靠 ,不牺牲主干血管 ,解剖恒定 ,充分利用“浅静脉—皮神经营养血管系统” ,皮瓣蒂部保留“彗星尾”状皮肤组织是转移后皮瓣成活的重要保证。

Objective To investigate the application of the island flap based on the postfemur neurocutaneous nutrient vessel. Methods The flap was designed and applied to repair the defects in the gluteal, popliteal fossa or the bilateral postfemur areas. A total of 11cases (12 defects) were treated with this method. The size of the defects ranged from 4 0 cm×7 8 cm to 8 3 cm×16 6 cm. Results Of the 12 defects, 9 achieved complete success. Epidermal necrosis occurred in the distal part of the flap in 3 defects owing to venous stasis, which were cured with skin grafting. Postoperative follow-up for 8～19 months showed that the appearance, texture, and function of the flap were satisfactory. Conclusions The advantages of the flap lie in the reliable blood supply, constant anatomy, and without sacrificing a major artery. The key points for the flap survival are utilizing the 'Superficial vein-nutrient vessel of the cutaneous nerve system' and retaining a comet tail-shaped soft-tissue pedicle in the flap creation. ;