摘要：
Objective To explore the effects of anteriolateral thigh perforator flap and fascia lata transplantation in combination with computed tomography angiography (CTA) on repair of electrical burn wounds of head with skull exposure and necrosis.Methods Seven patients with head electrical burns accompanied by skull exposure and necrosis were admitted to our burn center from March 2016 to December 2017.Head CTA was performed before the operation.The diameters of the facial artery and vein or the superficial temporal artery and vein were measured,and their locations were marked on the body surface.Preoperative CTA for flap donor sites in lower extremities were also performed to track the descending branch of the lateral circumflex femoral artery with the similar diameter as the recipient vessels on the head,and their locations were marked on the body surface.Routine wound debridement and skull drilling were performed successively.The size of the wounds after debridement ranged from 12 cm × 8 cm to 20 cm × 12 cm,and the areas of skull exposure ranged from 8 cm × 6 cm to 15 cm × 10 cm.Anteriolateral thigh perforator flaps with areas from 13 cm ×9 cm to 21 cm × 13 cm containing 5-10 cm long vascular pedicles were designed and dissected accordingly.The fascia lata under the flap with area from 5 cm × 2 cm to 10 cm × 3 cm was dissected according to the length of vascular pedicle.The fascia lata was transplanted to cover the exposed skull,and the anteriolateral thigh perforator flap was transplanted afterwards.The descending branch of the lateral circumflex femoral artery and its accompanying vein of the flap were anastomosed with superficial temporal artery and vein or facial artery and vein before the suture of flap.The flap donor sites were covered by intermediate split-thickness skin graft collected from contralateral thigh or abdomen.Results The descending branch of the lateral circumflex femoral artery and its accompanying vein were anastomosed with superficial temporal artery and vein in six patients,while those with facial artery and vein in one patient.All the flaps survived after the operation,and no vascular crisis was observed.Wound healing was satisfactory.One patient was lost to follow up.Six patients were followed up for 6 to 10 months.The patients were bald in the head operation area with acceptable appearance.No psychiatric symptom such as headache or epileptic seizure was reported.The flap donor sites were normal in appearance.The muscle strength of the lower extremities all reached grade V.The sensation and movement of the lower extremities were normal.Conclusions Anterolateral thigh perforator flap with fascia lata transplantation can effectively repair electrical burn wounds of head with skull exposure and necrosis.The fascia lata can be used to protect the vascular pedicle of flaps,which is beneficial to the survival of the flap.Preoperative head and lower extremities CTA can provide reference for intraoperative vascular exploration in donor site and recipient area,so as to shorten operation time.%目的 探讨CT血管造影(CTA)联合股前外侧穿支皮瓣加阔筋膜移植修复伴颅骨坏死外露头部电烧伤创面的效果. 方法 2016年3月-2017年12月,笔者单位收治7例伴颅骨坏死外露头部电烧伤患者.术前行头部CTA,测量面动静脉或颞浅动静脉直径并在体表相应位置进行标记;另行下肢供瓣区CTA,寻找与头部受区血管直径较吻合的旋股外侧动脉降支并在体表相应位置进行标记.常规扩创后行颅骨钻孔,扩创后创面面积为12 cm ×8 cm～20 cm×12 cm,颅骨外露面积为8 cm×6 cm～15 cm×10 cm,据此设计并切取面积为13 cm ×9 cm ～21 cm×13 cm带5～10 cm长血管蒂股前外侧穿支皮瓣.根据血管蒂长度切取面积为5 cm×2 cm～10 cm×3 cm皮瓣下阔筋膜,平铺于裸露颅骨上后转移皮瓣.缝合皮瓣前行皮瓣内旋股外侧动脉降支及其伴行静脉与受区颞浅动静脉或面动静脉吻合.供瓣区移植对侧大腿或腹部中厚皮封闭. 结果 6例患者旋股外侧动脉降支及其伴行静脉与颞浅动静脉吻合,1例与面动静脉吻合.术后皮瓣均成活,未见血管危象,术后创面愈合良好.1例患者失访.6例患者随访6 ～10个月,患者头部术区秃发,外形可,未见头痛、癫痫发作等精神症状;供瓣区外形恢复正常,下肢肌力均为V级,下肢感觉、活动均正常. 结论 采用股前外侧穿支皮瓣加阔筋膜移植可有效修复伴颅骨坏死外露头部电烧伤创面,其中阔筋膜可保护皮瓣血管蒂以利于皮瓣成活,术前行头部和下肢CTA能够为术中供受区的血管探查提供参考以缩短手术时间.
