摘要
目的探讨游离股前外侧双叶皮瓣修复儿童足踝部皮肤软组织缺损创面的临床疗效。方法自2015年7月至2020年6月,对苏州大学附属瑞华骨科医院小儿骨科收治的6例足踝部皮肤软组织缺损创面的患儿采用游离股前外侧双叶皮瓣修复,其中男5例,女1例;年龄范围在3~12岁,平均8岁;皮肤缺损大小范围在13.0 cm×6.0 cm~15.0 cm×12.0 cm;合并胫骨骨折1例、胫后动静脉断裂2例、腓浅神经断裂2例、合并肌肉及肌腱损伤的5例,仅皮肤缺损的1例,创面均有深部肌腱及骨外露,但未有肌腱等组织缺损。一期行骨折复位内固定,血管、神经、肌肉、肌腱修复,创面VSD覆盖,择期在静脉全麻下游离股前外侧双叶皮瓣修复。根据创面大小设计样布,在股前外侧区纵行设计双叶皮瓣,以方便皮瓣切取后供区能直接缝合,皮瓣切取总面积22.0 cm×4.0 cm~29.0 cm×7.5 cm。如果两块皮瓣血管同源,皮瓣内的主干血管直接与受区血管吻合并桥接受区血管;如果两块皮瓣不同源,则先通过内增压的方式并连成一个血管蒂的双叶皮瓣,再与受区血管吻合并桥接受区血管,大腿供区直接缝合。结果6例皮瓣全部成活,供区均未植皮,伤口均一期愈合,随访6~36个月,平均17个月。6例患儿皮瓣均存在不同程度的臃肿及供受区瘢痕增生,皮瓣色泽、质地接近周围皮肤,3例皮瓣行二次手术修薄整形,2例行供受区瘢痕切除术,术后恢复满意。供区除有瘢痕增生外,功能无影响。结论游离股前外侧双叶皮瓣是修复儿童足踝部皮肤软组织缺损创面的较好方法,具有血供可靠、供区损伤小等优点,适合临床推广,术后皮瓣臃肿、瘢痕增生等可通过二次手术改善。
Objective To explore the clinical efficacies of free anterolateral thigh bilobed flap for repairing skin and soft tissue defects of foot and ankle in children.Methods From July 2015 to June 2020,6 children with skin and soft tissue defects of foot and ankle were repaired with free anterolateral thigh bilobed flap.There were 5 boys and 1 girl with an average age of 8(3-12)years.The area of skin defect was 13.0×6.0-15.0×12.0 cm2.There were tibial fracture(n=1),posterior tibial artery&vein rupture(n=2),superficial peroneal nerve rupture(n=2),muscle&tendon injury(n=5)and skin defect(n=1).Deep tendon and bone exposure occurred in all wounds without tendon or bone defect.Fracture reduction and internal fixation,vasculature,nerve,muscle,tendon repair and coverage of wound by VSD(vacuum sealing drainage)were performed in one stage.Free anterolateral thigh bilobed flaps were performed in a second stage under intravenous general anesthesia.Cloth sample was prepared according to wound size and then bilobed flap designed longitudinally in anterolateral thigh.After flap harvest,direct suturing of wound was performed at donor site.The total area of flap was 22.0×4.0-29.0×7.5 cm2.For those with perforating branches of common trunk type,vascular truck of flap was anastomesed with recipient vessel.For those with perforating branches of double trunks type,turbocharging technique was applied after harvesting.The wound of thigh donor area was sutured directly.Results All flaps survived without skin grafting in donor area and wounds healed in one stage.The average follow-up period was 17(6-36)months.Swelling and scar formation appeared in donor area.Both color and texture of flaps were similar to the surrounding skin.Skin flap flattening(n=3)and scar resection(n=2)were performed.The postoperative recovery of plastic surgery was satisfactory.Except for scar hyperplasia,the function of donor area was not affected.Conclusions Free anterolateral thigh bilobed flap is ideal for repairing skin and soft tissue defects of feet and ankles in children.With the advantages of reliable blood supply and minimal injury in donor area,it is worth wider clinical popularization.Swelling flap and scar hyperplasia may be improved through re-peration.
作者
王桂洋
柳志锦
熊胜
段永明
刘胜哲
巨积辉
Wang Guiyang;Liu Zhijin;Xiong Sheng;Duan Yongming;Liu Shengzhe;Ju Jihui(Department of Hand Surgery,Affiliated Ruihua Orthopedic Hospital,Soochow University,Suzhou 215104,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2022年第10期926-931,共6页
Chinese Journal of Pediatric Surgery
基金
江苏省青年医学人才项目(QNRC2016224)
江苏省研究生科研与实践创新计划项目(SJCX20_1076)
苏州市民生科技项目关键技术应用研究(SS202092)
苏州市卫生科教临床重点病种诊疗技术专项(LCZX202026)。
关键词
外科皮瓣
股前外侧皮瓣
皮肤软组织缺损
儿童
足踝
Surgical flaps
Anterolateral thigh flap
Skin and soft tissue defect
Children
Ankle
