摘要
目的探讨采用游离旋股外侧动脉降支穿支皮瓣修复前臂大面积皮肤缺损的临床疗效。方法自2014年11月至2019年9月,采用游离旋股外侧动脉降支穿支皮瓣修复外伤致前臂大面积皮肤缺损患者12例,缺损面积为20 cm×19 cm^25 cm×9 cm,皮瓣切取面积为37 cm×10 cm^25 cm×9 cm。采用单叶皮瓣修复6例,分叶组合皮瓣修复6例。术中将皮瓣血管蒂动、静脉与前臂尺桡动脉及其伴行静脉吻合,其中7例保留的皮瓣内股前外侧皮神经与受区皮神经吻合;供区直接闭合。术后随访时观察皮瓣的成活、外观、质地、血运以及供受区皮肤愈合情况,同时测量皮瓣感觉恢复、肌力以及膝关节活动情况。结果 12例患者的皮瓣均成活,未发生感染、血管危象及下肢筋膜室综合征等并发症。随访6~36个月,皮瓣的外观、质地与周围组织相似,双侧上下肢体均较对称,无明显臃肿,血运良好,受区无明显的瘢痕增生;供瓣区切口较隐蔽,缝合后仅留线性瘢痕,肢体肌力正常,膝关节屈、伸活动正常。皮瓣感觉恢复S3级7例,S2级4例,S1级1例。结论采用游离旋股外侧动脉降支穿支皮瓣修复前臂大面积皮肤缺损,可获得较满意的功能恢复及外形,同时能减轻供区的损伤。
Objective To explore the clinical efficacy of free perforator flap of descending branch of lateral femoral circumflex artery in the repair of extensive skin defects of forearm.Methods From November 2014 to September 2019,12 patients with extensive skin defects of forearm were repaired by free perforator flap of descending branch of lateral femoral circumflex artery.The area of skin defects ranged from 20 cm×19 cm to 25 cm×9 cm.The area of flap ranged from 37 cm×10 cm to 25 cm×9 cm.Six patients were repaired by unilobular flap and 6 patients were repaired by lobulated composite flap.The artery and vein of vascular pedicle of the flap were anastomosed with the ulnar/radial artery of the forearm and its accompanying vein.The anastomosis of anterolateral femoral cutaneous nerve with cutaneous nerve of the recipient site was preserved in 7 patients.The donor site was directly sutured.During the follow-up after operation,the survival,appearance,texture,blood supply,skin healing of donor and recipient site were observed and recorded.The sensation recovery of flap,muscle strength and activity of knee joint were measured and recorded.Results All flaps survived in 12 patients.No complications such as infection,vascular crisis and lower extremity compartment syndrome occurred.After follow-up from 6 to 36 months,the appearance and texture of the flap were similar to that of the recipient site.The bilateral limbs were symmetrical and the blood circulation was good.No obvious swelling and scar hyperplasia occurred in the recipient site.The suture position of donor site was concealed and only a linear scar was left.The muscle strength of limb and flexion and extension activity of knee joint was normal.The sensation recovery of flap was S3 in 7 patients,S2 in 4 patients and S1 in 1 patient.Conclusion The application of free perforator flap of descending branch of lateral femoral circumflex artery in the repair of extensive skin defects of forearm can obtain satisfactory functional recovery and appearance.The damage of donor site also can be reduced.
作者
邢长泰
吴锦生
马俊伟
申林
刘岳
战杰
XING Chang-tai;WU Jin-sheng;MA Jun-wei;SHEN Lin;LIU Yue;ZHAN Jie(Department of Hand Surgery,The Affiliaued Central Hospital of Shenyang Medical College,Shenyang 110024,China)
出处
《中国美容整形外科杂志》
CAS
2020年第7期421-424,共4页
Chinese Journal of Aesthetic and Plastic Surgery
基金
社会公关及产业化指导计划(2019JH8/10300054)。
关键词
穿支皮瓣
旋股外侧动脉降支
移植
前臂皮肤缺损
Perforator flap
Descending branch of lateral femoral circumflex artery
Transplantation
Skin defects of forearm
