股前外侧穿支皮瓣游离移植在复杂创面修复中的应用及其并发症处理
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摘要
目的:评估游离股前外侧穿支皮瓣修复复杂创面的疗效,讨论手术并发症的原因及处理方法。方法:回顾笔者科室2015年1月-2018年8月收治的24例复杂创面患者的临床资料,共行25块股前外侧穿支皮瓣游离(肌皮瓣5例)移植修复创面。皮瓣切取面积8cm×10cm～20cm×20cm,术中吻合1根动脉,1～2根伴行静脉。结果:所有患者随访时间6～36个月,皮瓣均成活,其中术后2例出现血管危象,经血管探查及重新吻合、桥接血管后血管再通;2例皮瓣下积液,经换药处理后痊愈。皮瓣供区均无明显并发症发生。结论:应用游离股前外侧穿支皮瓣修复复杂创面效果良好,供区损伤小,针对血管危象等严重并发症,需做到早发现、早处理,手术是唯一有效治疗手段。
Objective To evaluate the curative effect of profitable anterolateral femoral skin flaps in repairing complex wounds, and to discuss the causes and treatment of surgical complications. Methods The clinical data of 24 patients with complex wounds treated in our department from January 2015 to August 2018 were reviewed. A total of 25 free anterolateral thigh perforator flaps(5 myocutaneous flaps) were transplanted to repair the wounds. The area of the flap was 8 cm×10 cm-20 cm×20 cm. One artery was anastomosed and one to two accompanying veins were anastomosed during the operation.Results All patients were followed up for 6 to 36 months, and the flaps survived. Among them, 2 cases had vascular crisis after operation, which was recanalized after vessel exploration, anastomosis and bridging. 2 cases had subcutaneous effusion and were cured after dressing change. There were no obvious complications in the donor site of the flaps. Conclusion Free anterolateral thigh perforator flaps are effective in repairing complex wounds with less damage to donor site. For serious complications such as vascular crisis, early detection and treatment are needed. Surgery is the only effective treatment.
Objective To evaluate the curative effect of profitable anterolateral femoral skin flaps in repairing complex wounds, and to discuss the causes and treatment of surgical complications. Methods The clinical data of 24 patients with complex wounds treated in our department from January 2015 to August 2018 were reviewed. A total of 25 free anterolateral thigh perforator flaps(5 myocutaneous flaps) were transplanted to repair the wounds. The area of the flap was 8 cm×10 cm-20 cm×20 cm. One artery was anastomosed and one to two accompanying veins were anastomosed during the operation.Results All patients were followed up for 6 to 36 months, and the flaps survived. Among them, 2 cases had vascular crisis after operation, which was recanalized after vessel exploration, anastomosis and bridging. 2 cases had subcutaneous effusion and were cured after dressing change. There were no obvious complications in the donor site of the flaps. Conclusion Free anterolateral thigh perforator flaps are effective in repairing complex wounds with less damage to donor site. For serious complications such as vascular crisis, early detection and treatment are needed. Surgery is the only effective treatment.
引文
[1]中华医学会显微外科学分会.MBCMA股前外侧皮瓣临床应用指南(2016征求意见稿)[J].中华显微外科杂志,2016,39(4):313-317.
[2]刘闪,周虹,谭谦,等.股前外侧并联穿支皮瓣的应用解剖与血管造影研究[J].中国美容整形外科杂志,2011,22(10):581-587.
[3]周虹,谭谦,刘闪,等.股前外侧皮瓣穿支动脉定位方法的研究及临床应用[J].中国美容整形外科杂志,2011,22(10):591-597.
[4]刘利华.复合组织瓣移植修复四肢严重创伤后皮肤缺损的临床研究[J].中国美容医学,2016,25(9):11-13.
[5]谭谦,陈曦,周宏礽,等.股前外侧穿支皮瓣游离移植在深度创面修复中的应用[J].江苏医药,2010,36(2):151-153.
[6]Spindler N,Al-Benna S,Ring A,et al.Free anterolateral thigh flaps for upper extremity soft tissue reconstruction[J].GMS Interdiscip Plast Reconstr Surg DGPW,2015,4:Doc05.
[7]任义军,胡锐,严立,等.股前外侧组织瓣修复下肢多处皮肤软组织缺损[J].中华显微外科杂志,2015,38(5):447-450.
[8]吴攀峰,唐举玉,李康华,等.旋股外侧动脉降支分叶穿支皮瓣临床应用16例[J].中华显微外科杂志,2015,38(6):526-529.
[9]Collins J,Ayeni O,Thoma A.A systematic review of anterolateral thigh flap donor site morbidity[J].Can J Plast Surg,2012,20(1):17-23.
[10]唐举玉,汪华侨,Hallock GG,等.关注皮瓣供区问题-减少皮瓣供区损害专家共识[J].中华显微外科杂志,2018,41(1):3-5.
[11]张军,刘晓雪.股前外侧皮瓣游离移植联合负压封闭引流技术修复下肢远端软组织缺损[J].中国美容医学,2018,27(6):25-27.
[12]Nahabedian MY,Momen B,Galdino G,et al.Breast reconstruction with the free TRAM or DIEP flap:Patient selection,choice of flap,and Outcome[J].Plast Reconstr Surg,2002,110(2):466-475.
[13]Steven PD,Mark WC,Andrew LK.Anatomy of free flap failures:dissection of a series[J].Modern Plastic Surg,2013(3):89-95.
[14]周喆刚,万圣祥,肖颖锋,等.游离皮瓣失败病例的原因及临床处理结果分析[J].实用骨科杂志,2016,22(9):802-805.
[2]刘闪,周虹,谭谦,等.股前外侧并联穿支皮瓣的应用解剖与血管造影研究[J].中国美容整形外科杂志,2011,22(10):581-587.
[3]周虹,谭谦,刘闪,等.股前外侧皮瓣穿支动脉定位方法的研究及临床应用[J].中国美容整形外科杂志,2011,22(10):591-597.
[4]刘利华.复合组织瓣移植修复四肢严重创伤后皮肤缺损的临床研究[J].中国美容医学,2016,25(9):11-13.
[5]谭谦,陈曦,周宏礽,等.股前外侧穿支皮瓣游离移植在深度创面修复中的应用[J].江苏医药,2010,36(2):151-153.
[6]Spindler N,Al-Benna S,Ring A,et al.Free anterolateral thigh flaps for upper extremity soft tissue reconstruction[J].GMS Interdiscip Plast Reconstr Surg DGPW,2015,4:Doc05.
[7]任义军,胡锐,严立,等.股前外侧组织瓣修复下肢多处皮肤软组织缺损[J].中华显微外科杂志,2015,38(5):447-450.
[8]吴攀峰,唐举玉,李康华,等.旋股外侧动脉降支分叶穿支皮瓣临床应用16例[J].中华显微外科杂志,2015,38(6):526-529.
[9]Collins J,Ayeni O,Thoma A.A systematic review of anterolateral thigh flap donor site morbidity[J].Can J Plast Surg,2012,20(1):17-23.
[10]唐举玉,汪华侨,Hallock GG,等.关注皮瓣供区问题-减少皮瓣供区损害专家共识[J].中华显微外科杂志,2018,41(1):3-5.
[11]张军,刘晓雪.股前外侧皮瓣游离移植联合负压封闭引流技术修复下肢远端软组织缺损[J].中国美容医学,2018,27(6):25-27.
[12]Nahabedian MY,Momen B,Galdino G,et al.Breast reconstruction with the free TRAM or DIEP flap:Patient selection,choice of flap,and Outcome[J].Plast Reconstr Surg,2002,110(2):466-475.
[13]Steven PD,Mark WC,Andrew LK.Anatomy of free flap failures:dissection of a series[J].Modern Plastic Surg,2013(3):89-95.
[14]周喆刚,万圣祥,肖颖锋,等.游离皮瓣失败病例的原因及临床处理结果分析[J].实用骨科杂志,2016,22(9):802-805.