摘要
目的评估股前外侧嵌合穿支肌皮瓣在修复下肢软组织缺损并处理深部死腔创面方面的治疗效果。方法2019年7月-2023年7月,对31例下肢软组织缺损和深部死腔创面的一期患者进行清创,二期采用股前外侧嵌合穿支肌皮瓣进行修复。结果31例股前外侧嵌合穿支肌皮瓣全部成活,其中1例术后出现皮瓣动脉危象,通过急诊手术探查后成功挽救了皮瓣血运;1例术后出现皮瓣静脉危象,经间断拆线、换药和配合药物治疗后皮瓣成活;2例皮瓣边缘出现少许皮肤坏死情况,经过及时换药处理最终伤口愈合良好。术后随访12~36个月,皮瓣形态优良、质地柔软,色泽接近正常,肢体功能恢复良好。皮瓣供区遗留切口瘢痕及植皮区色素沉着,未见功能影响或并发症的发生。其中7例皮瓣臃肿,影响穿鞋及美观,二期行皮瓣修薄术。结论股前外侧嵌合穿支肌皮瓣主干血管蒂长、管径粗,穿支丰富,一个血管蒂连带两块组织瓣,兼具股前外侧皮瓣和肌瓣的优点,既能填塞空腔,又能覆盖创面,是修复下肢软组织缺损合并深部死腔创面的优良选择。
Objective To evaluate the therapeutic effect of anterolateral thigh perforator myocutaneous flap in repairing soft tissue defects of lower extremities complicated with deep dead space wounds.Methods From July 2019 to July 2023,we performed debridement and repair in 31 patients,and used the anterolateral thigh chimeic perforator myocutaneous flap for the repair of lower limb soft tissue defects and deep dead space wounds.These patients had vascular,nerve,tendon,and bone damage.In the first stage of emergency repair,VSD was used temporarily to cover the wounds complicated with soft tissue defects,and in the second stage,the anterolateral thigh perforator myocutaneous flap was used to repair them.The second stage of surgery was performed under the condition of wound necrosis and infection(generally 2-4 weeks after the first stage of surgery)were controded,and the bacteria of the wound secretion was cultured in all the cases,among which 4 patients with positive bacterial culture were required to undergo re-debridement treatment and used sensitive antibiotics.After negative bacterial culture,the anterolateral thigh chimeric perforator myocutaneous flap was used for repair.Results All 31 cases of thigh anterolateral chimeric perforator myocutaneous flap survived successfully.One of the patients had the arterial crisis after operation,but the blood flow of the flap was successfully saved after emergency surgical exploration.In addition,1 patient experienced the venous crisis after surgery,which was gradually resolved and survived after intermittent suture removal,dressing change,and drug treatment.In addition,there was a little skin necrosis at the edge of the flap in 2 patients,but the wound healed well after timely dressing treatment.The results of follow-up showed that the skin flap of these patients had good shape,soft texture,and nearly normal color.Seven patients were troubled by the appearance of bloated skin flap,which affected the wearing of shoes and the esthetic appearance.The second stage skin flap thinning was selected,and the limb function recovered well.There were no functional effects or complications in the donor area and pigmentation in the skin graft area.Conclusion The anterolateral thigh chimeric perforator myocutaneous flap has long trunk vascular pedicle,thick tube diameter and abundant perforator branches.One vascular pedicle is associated with two tissue flap,which has the advantages of both anterolateral thigh flap and muscle flap.It can not only fill the cavity but also cover the wound,so it is a good choice for repairing the soft tissue defect of lower limbs combined with deep dead cavity wound.
作者
唐怀龙
谢久虎
吴信举
黄栋梁
徐帅令
朱自强
TANG Huailong;XIE Jiuhu;WU Xinju(Department of Hand Surgery,The Second Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu,221000,China)
出处
《实用手外科杂志》
2025年第3期275-279,共5页
Journal of Practical Hand Surgery
作者简介
唐怀龙(1991-),男,主治医师;通信作者:朱自强。
