摘要
目的设计以旋股外侧动脉降支为蒂的股前外侧和内侧双叶皮瓣，为修复肢体大面积软组织缺损和洞穿伤提供一种新技术。方法依据旋股外侧动脉降支的走行及其在股直肌两侧肌间隙中固有的皮肤穿支，设计同蒂的股前外侧和内侧双叶皮瓣。2004年12月至2006年5月，临床应用股前外侧和内侧双叶皮瓣移植5例，全部为男性。年龄23-45岁，平均32．2岁。车祸伤2例，机器致伤3例。受伤部位：前臂2例，腕部1例，小腿1例，足部1例。同时合并骨缺损2例。肢体大面积缺损2例，肢体洞穿伤3例。皮肤缺损面积：（6cm×5cm＋7cm×6cm）-（13cm×7cm＋17cm×8cm）。大腿供区行游离植皮。结果5例双叶皮瓣移植术后全部成活，1例于术后3个月接受皮瓣削薄术。全部病例随访4-10个月，平均8个月。双皮瓣外观和功能恢复满意。大腿供区植皮区轻度瘢痕，膝关节屈伸功能不受限。2例同期行骨移植者，术后4个月骨折开始愈合。结论以旋股外侧动脉降支为同一个血管蒂的股前外侧和内侧双叶皮瓣移植术血管吻合数量少，皮瓣移植成功率高，而手术风险并未增加，适合修复大面积软组织缺损和肢体洞穿伤。
Objective To develop a new twin-flap which is vascularized by descending branch of lateral circumflex femoral artery, and supply a new surgical techniques to repair large soft tissue defect and perforating injury in extremities. Methods According to the local anatomy of descending branch of lateral circumflex femoral artery, with constant hranchs in the two sides of rectus femoris muscle, the anterolateral and anteromedial thigh twin-flap vascularized by the same descending branch of lateral circumflex femoral artery was designed and harvested. From December 2004 to May 2006, this twin-flap was transferred in 5 male patients. The patients ranged in age from 23 to 45 years, average 32.2 years. 2 patients were damaged by motor accident, the others as a result of machine injuries. The defect position as follow： 2 cases of forearm, 1 wrist, 1 lower leg, 1 foot. Among them, 2 cases suffered from large soft tissue defect, the rest with perforating injury in extremities. The defect size was （6 cm ×5 cm ＋ 7 cm ×6 cm） -（13 cm×7 cm＋17 cm ×8 cm）. Two patients were involved the bone defect. The donor site of thigh were resurfaced by thickness skin graft. Results All transfering flaps were survival. Only 1 case accepted the twin-flap defatting in postoperative 3 months. In 4-10 months （average 8 months） follow-up, the satisfactory cosmetic appearances and functions were gained. The donor thigh present little scar and constracture, the function of knees maintain normal. Conclusion The twin-flap of thigh transfer based the descending branch of lateral circumflex femoral artery decreases the sum of vessel anastomosis and microsurgical risk, and presents a high rate of success. As the two flaps can gain considering mobile scope, it is an optimal method for coverage of large areas of soft tissue defect and reconstructure of perforating injuries in extremities.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2007年第8期600-603,共4页
Chinese Journal of Orthopaedics
关键词
外科皮瓣
软组织损伤
股动脉
Surgical flaps
Soft tissue injuries
Femoral artery
