摘要
目的探讨以腓肠内侧血管为受区血管的游离股前外侧皮瓣修复小腿严重皮肤软组织缺损的临床疗效。方法 2008年7月-2014年1月,收治小腿严重皮肤软组织缺损32例。男22例,女10例;年龄23~50岁,平均36.5岁。致伤原因:交通事故伤9例,重物砸伤15例,机器绞伤8例。左侧10例,右侧22例。伤后至入院时间1~4 h,平均2.5 h。创面部位:小腿胫前上1/3 15例,中1/3 10例,下1/3 7例。创面范围10 cm×5 cm^23 cm×9 cm。一期彻底清创,封闭式负压引流(vaccum sealing drainage,VSD)治疗,待创面肉芽组织新鲜后行二期修复手术;采用大小为12 cm×7 cm^25 cm×11 cm、以腓肠内侧血管为受区血管的游离股前外侧皮瓣修复创面。供区直接缝合或游离植皮修复。结果术后皮瓣及供区植皮均顺利成活,创面均Ⅰ期愈合。患者均获随访,随访时间6~23个月,平均14.5个月。皮瓣质地柔软,外观饱满,色泽与周围正常皮肤相似。术后6个月根据1954年英国医学研究会的评价标准,皮瓣感觉恢复至S2~S3+,供区无明显瘢痕挛缩。结论腓肠内侧血管解剖位置恒定、管径粗,以其作为受区血管的游离股前外侧皮瓣修复小腿严重皮肤软组织缺损,可获得较理想疗效。
Objective To discuss the effectiveness of free anterolateral thigh flap pedicled with medial sural vessels for treatment of leg skin and soft tissue defects. Methods Between July 2008 and January 2014, 32 cases of serious skin and soft tissue defects in the leg were repaired by using free anterolateral thigh flap pedicled with medial sural artery and vein. Of them, there were 22 males and 10 females, aged 23 to 50 years（mean, 36.5 years）. Defects were caused by traffic accidents injury in 9 cases, crash injury of heavy object in 15 cases, and machine twist injury in 8 cases. The left side was involved in 10 cases and the right side in 22 cases. The mean interval of injury and admission was 2.5 hours（range,1-4 hours）. The location was the upper, middle, and lower one third of the anterior tibia in 15 cases, 10 cases, and 7 cases respectively. The area of defect ranged from 10 cm×5 cm to 23 cm×9 cm. After debridement and vaccum sealing drainage treatment, the anterolateral thigh flap ranging from 12 cm×7 cm to 25 cm×11 cm pedicled with the medial sural vessels was used to repair the wound. The donor site was sutured directly or repaired with the skingrafts. Results All flaps and skingrafts survived after operation, and primary healing of wound was obtained. After 6-23 months（mean, 14.5 months）follow-up, all flaps were characterized by soft texture, good color, and satisfactory appearance. The sensation of the flaps were recovered to S2-S3＋ according to the Britain＇s Medical Research Council criteria at 6 months after operation. No obvious scar contracture was observed at donor site. Conclusion The medial sural artery has the advantages of constant anatomical position, large diameter, rich blood flow, and a long artery pedicle, so the medial sural vessels is an ideal choice as recipient vessels for the reconstruction of leg skin and soft tissue defect.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第7期804-806,共3页
Chinese Journal of Reparative and Reconstructive Surgery
