超回流技术在逆行股前外侧斜支皮瓣修复小腿上段软组织缺损的应用

摘要

目的 探讨超回流技术在逆行股前外侧斜支皮瓣修复小腿上段软组织缺损的应用. 方法 2012年10月至2017年3月,收治小腿上段软组织缺损患者11例,男8例,女3例,年龄26～59岁,平均43岁,致伤原因:交通伤7例,重物砸伤3例,机器绞伤1例;缺损范围为10 cm×5 cm～13 cm×10 cm,伴有骨折或钢板外露.根据缺损创面大小设计逆行股前外侧斜支皮瓣,皮瓣大小为14 cm×6 cm～16 cm×8 cm,均采用穿支伴行静脉与大隐静脉端端吻合进行超回流技术处理,供区直接缝合.通过微信随访3例,门诊复诊8例. 结果 11例逆行股前外侧穿支均来源于斜支,术后皮瓣均未发生动、静脉危象,11例皮瓣全部成活,未出现皮瓣尖端血运障碍.术后6～12个月随访,皮瓣成活良好,质地与周围皮肤接近,未见溃疡和骨外露,大腿供区无严重并发症,呈线形瘢痕. 结论 逆行股前外侧斜支皮瓣血管蒂长,超回流技术可以有效避免静脉危象,提高皮瓣成活质量以及成活率.%Objective To investigate the application of venous superdrainage technique based anterolateral thigh flap based on oblique branch for the soft tissue defect of proximal shank.Methods Between October,2012 and March,2017,11 cases of the soft tissue defect in proximal shank were treated.There were 8 males and 3 females with a mean age of 43 (range,26-59) years.Causes of injury:7 cases of traffic injury,3 cases of bruise,1 case of machine wound;The defect sizes ranged from 10 cm×5 cm to 13 cm×10 cm,with fracture or plate exposure.Accord ing to the size of the defect,the distally based anterolateral thigh flap was designed to repair the defect.The flap sizes ranged from 14 cm×6 cm to 16 cm×8 cm.The oblique branch and their accompanying vein with great saphenous vein was anastomosed to construct the venous superdrainage,and the donor site suture directly.Three cases followed-up by WeChat,and 8 cases by return visit.Results Distally based anterolateral thigh flaps were derived from oblique branches,and no arteriovenous crisis occurred postoperatively.Eleven flaps healed well after operation.There were no distal end blood supply disorder.Followed-up for 6-12 months,the flaps survived well.The texture was closed to the surrounding skin,and no ulcer exposed.There were no serious complications in donor site.And the thighs were linear scars.Conclusion The distally based anterolateral thigh flap based on oblique branch have a long vascular pedicle.The venous superdrainage technique can effectively avoid venous crisis,and improve the survival quality of the flap and the survival rate.