单一穿支营养的股前外侧双叶皮瓣移植修复九例前臂及手部创面

摘要

目的 探讨单一穿支营养的股前外侧双叶皮瓣移植修复前臂及手部创面的方法 及临床效果.方法 2013年1月至2017年9月,对台州市博爱医院收治的9例前臂及手部大面积皮肤软组织缺损的患者,采用单一穿支营养的股前外侧双叶皮瓣Kiss组合后移植修复.男7例,女2例,年龄18～65岁,平均35.2岁.皮瓣均以旋股外侧动脉降支第1肌皮穿支作为滋养血管,术中通过增加皮瓣长度、减少宽度使得供区直接缝合,然后经过分叶、重组将皮瓣移植修复受区创面.皮瓣总长度16.5～22.0cm,宽度5.0～7.0 cm;旋股外侧动脉降支与桡动脉吻合.术后随访观察皮瓣的外观、质地、功能及供区情况.结果 术后9例18叶皮瓣全部成活,其中1例1叶皮瓣术后出现张力性水泡,拆除几针缝线减张后成活.皮瓣及供区伤口一期愈合,无血管危象发生.随访3～24个月,平均10.5个月,皮瓣色泽好,质地柔软,弹性较好,4例患者皮瓣略显臃肿.供区肢体仅留一线性瘢痕,对关节功能无影响.结论 单一穿支营养的股前外侧双叶皮瓣血管恒定,血供可靠,手术操作简单,供区直接缝合,是修复前臂及手部大面积皮肤软组织缺损的理想方法之一.%Objective To evaluate the surgical technique and the clinical effect of the reconstruction of forearm and hand defects,using double foliated anterolateral thigh flap with a single perforator.Methods From January 2013 to September 2017,9 cases (forearm,n =3;hand,n =6) of the skin and soft tissue defects were reconstructed with double foliated anterolateral thigh flaps.The patients include 7 males and 2 females,with the mean age of 35.2 years(18-65 years).Blood supply of the double foliated flap was derived from the first musculocutaneous branches of the lateral femoral circumflex artery.The length and width of flaps were adjusted,to close the donor site directly.The descending branch of the lateral circumflex femoral artery was connected to the recipient vessels with end-to-end anastomosis.All cases were followed for the evaluation of appearance,texture,function and donor site condition.Results All flaps survived,and all cases were followed for 3 to 24 months (average 10.5 months).All flaps showed no blood circulation disorder.Except for 4 cases had slightly bloated flap,the other flaps had fine appearance and texture.The donor site left only a linear scar,and the donor thigh had no functional deficiency.Conclusions Double foliated anterolateral thigh flap for repairing the large area of the skin and soft tissue defect in hand and forearm could simplify the operation,shorten operation time and reduce operation trauma.It is an ideal method to repair the skin and soft tissue defect of forearm and hand.