游离股前外侧穿支嵌合阔筋膜瓣修复手腕部及足踝部复合组织缺损
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摘要
目的探讨游离股前外侧穿支嵌合阔筋膜瓣修复手腕部及足踝部复合组织缺损的临床效果。方法回顾性分析采用游离股前外侧穿支嵌合阔筋膜瓣修复手腕部及足踝部复合组织缺损21例,观察其成活率、外形和术后功能,评价应用该嵌合皮瓣修复手腕部及足踝部复合组织缺损的临床应用价值。结果 1例皮瓣于术后15 h发生静脉血管危象,经过探查后顺利成活,其他所有皮瓣一期均顺利成活。供受区创面均一期愈合,术后随访时间6～18个月,平均(11. 47±3. 30)个月。皮瓣色泽、质地良好,皮瓣有不同程度臃肿,有9例患者二期行皮瓣修薄术。按中华医学会手外科学会上肢功能评定标准,优14例,良7例。结论游离股前外侧穿支嵌合阔筋膜瓣是一期修复手腕部及足踝部复合组织缺损的一种较为理想的方法。
Objective To investigate the clinical effect of free anterolateral thigh perforator flap with fascia lata flap in repairing composite tissue defect at dorsal of hand and wrist,ankle and foot. Methods Retrospective analysis of the free anterolateral thigh perforator flap with fascia lata flap to repair the hands and feet back composite tissue defects was 21 cases. The survival rate,postoperative function,shape were observed and the clinical value of the chimeric flap in repairing the complex tissue defect of the hand and wrist,ankle and foot were evaluated. Results A patient with venous vascular crisis occurred 15 hours after the operation of the skin flap. All other flaps were successfully survived. The wounds in the donor site healed at stage I. The postoperative follow-up time was 6 to 18 months,average( 11. 47 ± 3. 30) months. The flaps color and texture were good. The flaps area were bloated in different degrees. There were 9 cases in two stages of flap thinned. According to the evaluation standard of upper limb function of Chinese society of hand surgery,there were 14 excellent cases and 7 good cases. Conclusion The free anterolateral thigh perforator flap with fascia lata flap is an ideal method for the repair of complex tissue defect at hand and wrist,ankle and foot.
Objective To investigate the clinical effect of free anterolateral thigh perforator flap with fascia lata flap in repairing composite tissue defect at dorsal of hand and wrist,ankle and foot. Methods Retrospective analysis of the free anterolateral thigh perforator flap with fascia lata flap to repair the hands and feet back composite tissue defects was 21 cases. The survival rate,postoperative function,shape were observed and the clinical value of the chimeric flap in repairing the complex tissue defect of the hand and wrist,ankle and foot were evaluated. Results A patient with venous vascular crisis occurred 15 hours after the operation of the skin flap. All other flaps were successfully survived. The wounds in the donor site healed at stage I. The postoperative follow-up time was 6 to 18 months,average( 11. 47 ± 3. 30) months. The flaps color and texture were good. The flaps area were bloated in different degrees. There were 9 cases in two stages of flap thinned. According to the evaluation standard of upper limb function of Chinese society of hand surgery,there were 14 excellent cases and 7 good cases. Conclusion The free anterolateral thigh perforator flap with fascia lata flap is an ideal method for the repair of complex tissue defect at hand and wrist,ankle and foot.
引文
[1]胡朝波,邱勋永,范小军,等.游离足背皮瓣带趾伸肌腱修复手背复合组织缺损的临床应用[J].中华手外科杂志,2017,4:258-260.
[2]丁俊杰,李康,张斌杰,等.移植修复术在肌腱损伤伴足背复合组织缺损治疗中的应用[J].临床和实验医学杂志,2015,6:499-501.
[3] Figl M,Mayer M,Lederer S,et al. Extensor pollicis longus rupture after distal radius fracture:results of reconstruction by transposition of the extensor indicis tendon and postoperative dynamic splinting[J]. Wiener Klinische Wochenschrift,2011,123(15/16):485-487.
[4]刘承伟,刘福尧,邱冰,等.切取阔筋膜的股前外侧皮瓣在足踝皮肤肌腱缺损中的应用[J].中华显微外科杂志,2015,38(4):382-383.
[5]潘生德,顾玉东,侍德.中华医学会手外科学会上肢部分功能评定试用标准[J].中华手外科杂志,2000,16(3):130.
[6]张世民,徐达传,俞光荣,等.复(组)合皮瓣的分类、供区及临床应用[J].中国临床解剖学杂志,2005,6:670-673.
[7]张万锋,梁锋,李金有,等.带阔筋膜的股前外侧穿支组织瓣修复组织缺损[J].中华烧伤杂志,2013,29(5):427-431.
[8] Maegawa N,Yajima H,Shigematsu K,et al. Functional Reconstruction of bilateral injuries to the dorsum of hand using radial forearm tendocutaneous flaps[J]. Journal of Plastic Surgery and Hand Surgery,2014,48(6):426-428.
[9] Moriyama M. Vascularized tendon grafting in the rabbit[J]. Journal of Reconstructive Microsurgery,1992,8(2):83-91.
[10]魏在荣.皮瓣血供模式分类方式初步报告[J].遵义医学院学报,2012,35(4):344-346.
[11]宋达疆,李赞,周晓,等.股前内侧接力穿支皮瓣修复游离股前外侧穿支皮瓣供区的临床应用[J].中国修复重建外科杂志,2017,1:52-56.
[2]丁俊杰,李康,张斌杰,等.移植修复术在肌腱损伤伴足背复合组织缺损治疗中的应用[J].临床和实验医学杂志,2015,6:499-501.
[3] Figl M,Mayer M,Lederer S,et al. Extensor pollicis longus rupture after distal radius fracture:results of reconstruction by transposition of the extensor indicis tendon and postoperative dynamic splinting[J]. Wiener Klinische Wochenschrift,2011,123(15/16):485-487.
[4]刘承伟,刘福尧,邱冰,等.切取阔筋膜的股前外侧皮瓣在足踝皮肤肌腱缺损中的应用[J].中华显微外科杂志,2015,38(4):382-383.
[5]潘生德,顾玉东,侍德.中华医学会手外科学会上肢部分功能评定试用标准[J].中华手外科杂志,2000,16(3):130.
[6]张世民,徐达传,俞光荣,等.复(组)合皮瓣的分类、供区及临床应用[J].中国临床解剖学杂志,2005,6:670-673.
[7]张万锋,梁锋,李金有,等.带阔筋膜的股前外侧穿支组织瓣修复组织缺损[J].中华烧伤杂志,2013,29(5):427-431.
[8] Maegawa N,Yajima H,Shigematsu K,et al. Functional Reconstruction of bilateral injuries to the dorsum of hand using radial forearm tendocutaneous flaps[J]. Journal of Plastic Surgery and Hand Surgery,2014,48(6):426-428.
[9] Moriyama M. Vascularized tendon grafting in the rabbit[J]. Journal of Reconstructive Microsurgery,1992,8(2):83-91.
[10]魏在荣.皮瓣血供模式分类方式初步报告[J].遵义医学院学报,2012,35(4):344-346.
[11]宋达疆,李赞,周晓,等.股前内侧接力穿支皮瓣修复游离股前外侧穿支皮瓣供区的临床应用[J].中国修复重建外科杂志,2017,1:52-56.