摘要
自从股前外侧穿支皮瓣(Anterolateral Thigh Perforator Flap,ALTPF)被发现以来,其对日常生活中出现的高能损伤的修复效果极为突出。目前对于ALTPF修复复杂创面的临床研究甚多,尤其在修复四肢创伤方面,在定义、解剖、皮瓣设计、创面修复及术后护理等方面均有研究。该文章通过查阅ALTPF修复四肢创伤的相关文献,针对如下问题进行综述:ALTPF的解剖及穿支血管的位置因人而异,血管的穿支类型复杂多样,对手术的难易有直接影响,因此ALTPF的供区穿支血管的选取有较大争议。随着多普勒超声血流探测仪、CT血管造影及磁共振血管造影技术的发展,各项研究显示,三者相互结合、综合应用,才能为术前供区及受区穿支血管的定位提供保障。ALTPF在四肢创伤修复方面不仅能修复日常生活中的复杂创面,对长期感染创口、慢性骨髓炎等难治骨科疾病也有突出的疗效。且对于儿童及糖尿病患者等血管条件较差的患者,ALTPF移植术有良好的效果。ALTPF作为一种临床常见的修复复杂创面的治疗手段,如何在术后护理中有效抗感染,保障皮瓣成活,也是探索四肢创伤修复的关键。随着生活水平的提高、显微外科手术的进步,皮瓣移植不仅要恢复功能,人们对皮瓣移植手术后的美观要求也日益提高。但现阶段皮瓣移植手术仍有对医疗条件要求较高、治疗周期长、花费较为巨大、手术风险较高等弊端。因此在将来,如何利用ALTPF快速有效治疗,减少手术风险、降低手术费用,以及中西医综合治疗,才是四肢损伤修复的关键。
Since the discovery of anterolateral thigh perforator flap(ALTPF),it has been very effective in repairing high-energy injuries in daily life.At present,there are many clinical studies on ALTPF for the repair of complex wounds,especially in the repair of wounds of extremities.Studies have been conducted in the aspects of definition,anatomy,flap design,wound repair and postoperative care.By referring to the relevant literature of ALTPF in limb trauma repair,this paper summarizes the following issues:The anatomy of ALTPF and the location of perforator vessels vary from person to person,and the types of perforator vessels are complex and diverse,which have a direct impact on the difficulty of surgery.Therefore,the selection of perforator vessels in the donor area of ALTPF is highly controversial.With the development of Doppler ultrasound flowmetry,CTA and MRA technology,various studies have shown that the combination and comprehensive application of the three can guarantee the preoperative localization of the donor and recipient perforating vessels.ALTPF not only can repair complex wounds in daily life,but also has outstanding efficacy in the treatment of refractory orthopedic diseases such as long-term infection wounds and chronic osteomyelitis.In addition,ALTPF transplantation also has a good effect on children and diabetic patients with poor vascular conditions.ALTPF is a common therapeutic method for repairing complex wounds in clinic.How to effectively resist infection and ensure the survival of skin flap in postoperative nursing is also the key to explore limb trauma repair.With the improvement of living standard and the progress of microsurgery,lap grafting has become more than just restoring function,the aesthetic requirements after skin flap transplantation are increasing day by day.However,at present,the operation of skin flap transplantation still has some disadvantages such as high requirement for medical conditions,long treatment period,huge cost and high operation risk.Therefore,in the future,how to use fast and effective ALTPF treatment to reduce the risk and the cost of surgery,and integrate treatment of TCM and Western medicine,is the key to the repair of limbs injury.
作者
刘润青
李刚
张敬周
刘源
刘恩旭
盛韦菖
LIU Runqing;LI Gang;ZHANG Jingzhou;LIU Yuan;LIU Enxu;SHENG Weichang
出处
《中医临床研究》
2023年第27期113-116,共4页
Clinical Journal Of Chinese Medicine
关键词
股前外侧穿支皮瓣
四肢创伤修复
临床研究
Anterolateral thigh perforator flap
Limb trauma repair
Clinical research
