带肌瓣的嵌合穿支皮瓣修复合并深部死腔的难愈性创面

目的探讨带肌瓣的嵌合穿支皮瓣修复合并深部死腔难愈性创面的临床效果。方法2015年2月至2019年2月,中国人民解放军联勤保障部队第九四○医院全军烧伤整形外科中心收治22例合并有深部死腔的难愈性创面患者,男17例,女5例,年龄17~72岁,平均36.4岁。6例位于足底,6例位于小腿及踝关节,5例位于会阴部,2例位于肘部,2例位于背部,1例位于眼眶处。缺损创面:5 cm×4 cm^16 cm×11 cm,死腔范围:3 cm×2 cm^10 cm×4 cm。14例采用股前外侧嵌合穿支皮瓣游离移植修复,5例采用股前外侧嵌合穿支皮瓣带蒂修复,1例采用腓动脉嵌合穿支皮瓣带蒂修复,1例采用腓浅动脉嵌合穿支皮瓣带蒂修复,1例采用胫后动脉嵌合穿支皮瓣带蒂修复。术后对创面和功能进行随访。结果本组22例,皮瓣面积为6 cm×5 cm^17 cm×12 cm,肌瓣面积为3 cm×2 cm^10 cm×4 cm。1例腓浅动脉穿支嵌合皮瓣术后皮瓣边缘拆线后裂开形成创面,经换药后二期手术植皮愈合;1例股前外侧嵌合穿支皮瓣术后出现皮下窦道,换药清创后创面愈合;其余20例嵌合穿支皮瓣均成活良好。随访3~18个月,创面外形、功能均恢复满意。结论带肌瓣的嵌合穿支皮瓣中肌瓣填充死腔,皮瓣覆盖创面,可同时修复深部死腔和体表创面,是修复合并深部死腔的难愈性创面的良好方法。     

股前外侧穿支皮瓣修复足踝部软组织缺损

目的 探讨游离股前外侧穿支皮瓣修复足踝部皮肤软组织缺损的临床效果.方法对18例足踝部皮肤软组织缺损患者进行皮瓣移植,缺损面积9 cm×6 cm～26 cm×15 cm.受区彻底清创,切取股前外侧穿支皮瓣修复创面.结果 18例均获得随访,时间6～12个月.皮瓣全部成活（其中2例皮瓣术后发生血管危象,经手术探查处理后成活）,皮瓣色泽、弹性、厚度均为优良,供区及受区外观均满意.结论 股前外侧穿支皮瓣供区隐蔽,用于足踝部皮肤软组织缺损修复,临床效果良好.     

游离穿支皮瓣修复足踝部软组织缺损的临床效果

背景：足踝部软组织缺损是创伤骨科临床治疗难点,皮瓣移植仍然是不可替代的治疗手段之一。目的：探讨利用两种不同游离穿支皮瓣修复足踝部软组织缺损的临床技术。方法：2006年8月至2012年4月,30例足踝部软组织缺损伴骨外露患者行皮瓣移植术。男24例,女6例,年龄3～52岁,平均28岁。术前应用负压封闭引流技术处理,创面范围6cm×8cm-11cm×23cm。其中游离胸脐穿支皮瓣修复12例,游离股前外侧穿支皮瓣修复18例。结果：术后30例皮瓣全部成活。随访时间为3～24个月,平均11．0个月。皮瓣修复后外形大部分满意,皮瓣末梢二点分辨觉为10-22mm,胸脐穿支皮瓣和股前外穿支皮瓣组术后3个月左右恢复S2以上感觉百分比分别达58．3％和68．8％。结论：足踝部软组织缺损的游离皮瓣选择采用股前外穿支皮瓣或胸脐动脉穿支皮瓣均可。穿支皮瓣能够减少二次手术比例。负压封闭引流技术能显著减少皮瓣感染比例。     

The proximal pedicled anterolateral thigh flap for lower limb coverage

Although primarily considered as a versatile free-flap donor site, the anterolateral thigh can also be a source of a local muscle perforator flap. This attribute has previously been rarely considered for lower limb coverage. This small series of 3 additional cases demonstrates the usefulness of a proximal pedicled anterolateral thigh flap for medial and lateral thigh wounds. This flap can also be part of a combined flap, in particular when transferred with the vastus lateralis muscle as a local chimeric flap. The peninsular version of the anterolateral thigh local flap avoids venous congestion and is very reliable. The orthograde pedicled anterolateral thigh muscle perforator flap should be considered as another useful alternative for any upper thigh wound if a flap is essential.     

游离股前外侧穿支皮瓣修复胫前皮肤软组织缺损

目的探讨应用游离股前外侧穿支皮瓣移植修复胫前皮肤、软组织缺损的临床效果。方法对14例胫前皮肤、软组织缺损伴骨外露患者,应用游离股前外侧穿支皮瓣移植修复,皮瓣切取面积14cm×6cm～23cm×12cm,供区直接缝合或以全厚皮片植皮修复。结果术后14例皮瓣全部存活,创面一期愈合,术后随访3～24个月(平均8个月),皮瓣质地优良,无溃疡发生,8例获保护性感觉,骨折愈合后下肢可负重行走。结论股前外侧穿支皮瓣是修复胫前皮肤、软组织缺损的有效方法。     

以旋股外侧动脉降支为蒂的穿支嵌合皮瓣修复口腔颌面部缺损

目的 设计以旋股外侧动脉降支为蒂的股部皮肤穿支血管的嵌合皮瓣,为修复口腔颌面部的大面积、复杂的洞穿性缺损提供一种新的方法.方法 根据旋股外侧动脉降支的走行及分支、其在股部正面及两侧可能存在的皮肤穿支血管,设计以旋股外侧动脉降支为蒂的穿支嵌合皮瓣修复口腔颌面部软组织缺损8例.此种皮瓣可分为3种类型:股前外侧皮瓣+股前内侧皮瓣、股前外侧皮瓣+股直肌穿支皮瓣、股前外侧皮瓣+股前外侧皮瓣.结果 术后8例16块皮瓣均成活,无并发症,且供区均直接拉拢缝合,未行皮片移植.术后随访1～9个月,患者面部外形和功能均良好,供区畸形和功能障碍均不明显.结论 以旋股外侧动脉降支为血管蒂的穿支嵌合皮瓣吻合血管数量少,较切取2个皮瓣供区损伤小,组织量大,适合口腔颌面部大型复杂的组织缺损的修复.     

股前外侧穿支皮瓣桥接旋髂浅动脉蒂组织瓣组合移植修复四肢骨与软组织缺损

目的 探讨股前外侧穿支皮瓣桥接旋髂浅动脉蒂组织瓣组合移植修复四肢骨与软组织缺损的应用特点.方法 回顾性分析2009年3月至2011年1月,用股前外侧穿支皮瓣制备血流桥接皮瓣串联旋髂浅动脉为蒂的髂骨骨皮瓣、髂骨膜骨瓣或皮瓣修复10例四肢骨与软组织缺损患者资料,男9例,女1例;年龄21～57岁,平均39.7岁;血流桥接髂骨骨皮瓣7例,髂骨膜骨瓣2例,髂腹股沟皮瓣1例;重建手3例,足4例,小腿3例;平均皮肤缺损面积20 cm×9.7 cm.结果 股前外侧穿支皮瓣平均17.8 cm×9.4 cm,髂腹股沟皮瓣平均8.4 cm×4.5 cm,髂骨膜骨瓣平均5.4 cm×2.1 cm×0.8 cm,血管桥平均长10.5 cm.1例髂骨骨皮瓣远端部分坏死,经换药后植皮愈合,余皮瓣顺利成活.10例患者均获得6～36个月(平均12个月)随访.手损伤者平均骨愈合时间3个月,平均臂肩手残疾问卷评分43分;足损伤者平均骨愈合时间4个月,日本外科协会足部疾患治疗效果评分平均71.3分;小腿损伤者平均骨愈合时间4.5个月,Puno等评分平均91分.供区瘢痕颜色白、平软,6例大腿瘢痕增宽,2例瘢痕周围有麻木感,3例髂腹股沟区瘢痕增宽.结论 股前外侧穿支皮瓣桥接旋髂浅动脉蒂组织瓣移植可自由调整组织瓣位置,供区副损伤小,是修复大面积、结构复杂或类型特殊四肢骨与软组织缺损的一种较好方法.     

股前外侧皮瓣远侧肌皮穿支的解剖学研究与临床应用

目的 研究供养股前外侧皮瓣的远侧肌皮穿支的解剖特征及其在股前外侧皮瓣移植中的应用价值.方法 2007年7月至2009年12月,对10例新鲜尸体及96例应用股前外侧皮瓣修复创面病例的远侧肌皮支进行解剖学观察.临床应用股前外侧远侧肌皮穿支皮瓣修复四肢软组织缺损35例,男19例,女16例;年龄28～55岁,平均38.5岁;单瓣20例,分叶皮瓣15例.单瓣切取面积7 cm×15cm～9 cm×25 cm,分叶皮瓣切取面积5 cm×7 cm～8 cm×20 cm.皮瓣切取时间1～1.5 h.结果 组织瓣移植全部成活32例,部分性坏死3例.术后随访6～11个月,平均7.8个月.1例患者术后早期主诉膝关节不稳定感,术后6个月改善.尸体解剖研究发现:位于髂前上棘与髌骨外上缘连线远1/4段内的皮支均以肌皮穿支的形式出现,肌皮支穿出部位靠近股外侧肌前内缘,不超过肌肉横径1/2,一般在肌肉横径的1/3以内;远侧肌皮支主要来源于旋股外侧血管降支,1例2侧来源于股动脉,1例2侧来源于股深动脉穿支.临床解剖观察发现:94例出现2～5个远侧肌皮穿支,2例无远侧肌皮穿支,其主干旋股外侧动脉降支变异为直接肌皮支,近端有肌间隔肌皮支出现.结论 远侧肌皮穿支相对恒定,可以作为股前外侧皮瓣近侧肌皮支缺如病例的替代血管,也是实现分叶皮瓣移植的解剖基础.

Abstract：

Objective To investigate the anatomical characteristics and clinical application of the distal musculocutaneous perforators derived from the descending branch of lateral circumflex femoral artery in the anterolateral thigh flap transplantation. Methods From July 2007 to December 2009, the anatomic variations of musculocutaneous perforator were investigated in 96 cases who received anterolateral thigh flap and 10 preserved cadavers. Thirty-five cases who received the anterolateral thigh flap using the distal musculocutaneous perforators were included in the study. There were 19 males and 16 females. The age ranged from 28-55 years old, with an average of 38.5 years old. Single flap was used in 20 cases while lobulated flap in 15 cases. Single flap area ranged from 7 cm×15 cm to 9 cm×25 cm, lobulated flap ranged from 5 cm×7 cm to 8 cm×20 cm. Results The cadaver study found that the most musculocutaneous perforators were concentrated in the far fourth of the anterolateral thigh region. The musculocutaneous perforators commonly arose from the the lateral femoral circumflex artery. The perforator arose directly from the femoral artery or the deep femoral artery in one case separately. In the clinical study, 2-5 musculocutaneous perforators were found in 94 cases but not in the other 2 cases. The descending branch of lateral circumflex femoral artery became the direct m musculocutaneous perforator. The proximal intermuscularseptum perforator was found in 2 cases. Postoperative follow-up time ranged from 6-11 months. All flaps survived in the follow-up.Marginal necrosis was found in 3 cases. Only 1 case had complained of knee joint instability. Conclusion The results of this study suggest that the vascular anatomy of the distal musculocutaneous perforator was reliable. The perforator may serve as an option for proximal one in anterolateral thigh flap transplantation.     

Novel Design of the Chimeric Deep Inferior Epigastric Artery Perforator Flap that Provides for Three‐Dimensional Reconstruction of Composite Tissue Defects of the Heel in Children

ObjectiveThe aim of the present study was to report a novel design of the chimeric deep inferior epigastric artery perforator flap (DIEP) to achieve dead space filling, Achilles tendon bridging, and skin resurfacing simultaneously with minimal donor‐site morbidity.MethodsFrom September 2012 to May 2016, a retrospective study was carried out on six pediatric patients with composite soft tissue defects of the heel that were repaired with the chimeric DIEP flap. The chimeric flap design included a flap of the anterior sheath of the rectus, a block of rectus muscle, and a large skin paddle. All the parts were supplied by a common artery. After harvesting the flap, all element parts were inserted at the corresponding sites in a tension‐free manner. With one set of vessel anastomoses at the recipient site, accurate repair with tendon reconstruction, dead space elimination, and wound covering were accomplished. The donor site incisions were closed initially. Data on patient age, medical history, injury severity, defect size, flap dimensions, recipient vessels, donor site closure, complications, and follow‐up were collected and reviewed.ResultsFive of the six chimeric DIEP flaps survived without complications. The remaining one case experienced partial necrosis of the skin paddle caused by venous congestion, which healed after routine dressing changes. Primary donor site closure was accomplished in all cases. The mean follow‐up was 18.6 months (range, 10–36 months). Five patients had satisfactory aesthetic and functional outcomes; one patient needed a secondary debulking procedure. Compared to the unaffected side, the affected side showed no obvious difference for ankle movement, tiptoe function, and patient gait during the follow‐up period. Good ankle function was observed in all patients. There was no donor site breakdown, with only a slightly noticeable linear scar.ConclusionThe chimeric DIEP flap reduced the operative time, solved the problem of deficiency of recipient vessels, and attained satisfactory functional and aesthetic outcomes with low donor site morbidity. Therefore, it is a promising option for three‐dimensional reconstruction of composite defects with dead space and Achilles tendon defects as well as skin loss in children.

We reported a novel design of the chimeric deep inferior epigastric artery perforator flap (DIEP). The chimeric DIEP flap reduced the operative time, solved the problem of the deficiency of recipient vessels, and attained satisfactory functional outcomes. Therefore, it could be a promising option for three‐dimensional reconstruction of composite defects in children.     

股前外侧游离穿支皮瓣修复头面部和四肢肿瘤切除后软组织缺损

目的探讨应用股前外侧穿支皮瓣,修复头面部和四肢肿瘤切除术后的方法及其效果。方法2004年4月-2006年4月,收治头面部及四肢肿瘤切除术后造成的软组织缺损,采用股前外侧穿支皮瓣游离移植共16例,男13例,女3例;年龄26-72岁。头面部肿瘤9例,其中头顶部基底细胞癌1例,面部鳞状细胞癌4例（包括肿瘤复发1例）,腮腺癌4例;软组织缺损范围8cm×6cm-20cm×13cm,病程6-24个月。四肢肉瘤7例,其中上肢2例,下肢4例,小腿复发1例;软组织缺损范围10cm×7cm-21cm×12cm,病程2-18个月。结果16例应用股前外侧穿支皮瓣游离移植修复,15例皮瓣全部成活,1例皮瓣远端约2.5cm宽范围缺血坏死;14例创口期愈合;2例创口期愈合,其中1例经切除坏死组织,直接缝合后期愈合,另1例创口有3cm裂口,经换药后期愈合。术后随访1-18个月,肿瘤无复发,供受区外观良好,平整,无明显瘢痕及功能影响;受区修复效果满意。结论股前外侧穿支皮瓣游离移植,修复效果好,对供区损伤小,是一种较理想的修复头面和四肢肿瘤切除术后软组织缺损的方法。     

Alternative Regional Flaps When Anterolateral Thigh Flap Perforator is not Feasible

This paper presents the scheme to select alternative flaps limited to the region of the ipsilateral thigh when the perforator of the anterolateral thigh flap is not feasible. Total of 564 consecutive microsurgery cases using anterolateral thigh perforator flap was reviewed from March of 2001 to January of 2009. Total of 12 cases used a contingent flap due to anatomical and technical complications of the anterolateral thigh perforator. The alternatives were skin perforator flaps adjacent to the initial flap (3 cases of upper anterolateral thigh flap, 4 cases of anteromedial thigh flap), vastus lateralis muscle flap with skin graft (2 cases), and anterolateral thigh flap as septocutaneous flap without a prominent perforator on the septum (3 cases). All flaps survived and provided coverage as planned but one case using septocutaneous flap without a prominent perforator was noted with partial necrosis. Adjacent flaps around the anterolateral thigh perforator flap may provide useful alternative flaps in cases of failed elevation. Limiting the contingent secondary flap to this region may reduce further donor site morbidity and still provide an adequate flap for reconstruction.     

显微修薄股前外侧穿支皮瓣游离移植修复足踝部软组织缺损

目的：探讨显微修薄股前外侧穿支皮瓣游离移植修复足踝部软组织缺损方法及其临床效果。方法 ：自2017年3月至2022年1月,采用显微修薄股前外侧穿支皮瓣游离移植修复足踝部软组织缺损20例患者,男13例,女7例,年龄22～58(36.45±12.36)岁。切取皮瓣面积为8.0 cm×5.0 cm～20.0 cm×12.0 cm。术前先用便携式多普勒探测仪探测股前外侧区穿支血管位置,标记。对于创面缺损宽度<8 cm,11例采用单一皮瓣修复;对于创面宽度>8 cm无法直接缝合,9例采用分叶皮瓣技术,化宽度为长度,供区直接闭合者。所有皮瓣显微镜下以蒂部为中心向周边呈阶梯式修薄。观察皮瓣的成活情况及外形、质地、感觉功能恢复,采用Maryland足功能评定标准评价足部功能恢复情况。结果：移植20例显微修薄股前外侧穿支皮瓣全部成活。其中1例因皮下血肿发生静脉危象,经拆除缝合,清除血肿后危象解除,皮瓣顺利成活。供、受区创面愈合良好,供区仅遗留线状瘢痕。20例术后均获随访,时间3～26个月,皮瓣外形美观,不臃肿,质地优良,游离皮瓣两点辨别觉为9.0～16.0 mm,恢复保护性感觉,踝部屈伸功能...     

Reconstruction of Soft Tissue Defects in the Hand with a Free Anterolateral Thigh Deep Fascia Flap

ObjectiveTo report our experience in the reconstruction of soft tissue defects in the hand with a free anterolateral thigh deep fascia flap and describe the clinical outcomes.MethodsThis study was a retrospective trial. From November 2016 to January 2020, six patients (four men and two women) with soft tissue defects in the hand were included in this study. The average age of the patients was 33.7 ± 12.7 years (range, 20 to 50 years). All patients underwent reconstructions with free anterolateral thigh deep fascia flaps. Relevant clinical characteristics were recorded prior to surgery. The size and thickness of the deep fascia flap and the thickness of the skin were measured intraoperatively. The survival of the flaps and skin grafts and the occurrence of infection were recorded after the operation. At follow‐up, donor site complications and postoperative effects were evaluated according to the outcome satisfaction scale. The pain in the injured hand was assessed using the visual analog scale.ResultsThe average body mass index (BMI) was 26.6 ± 1.7 kg/m² (range, 23.9 to 28.7 kg/m²). The defect sizes ranged from 5 cm × 5 cm to 13 cm × 8 cm (average, 53.1 ± 27.9 cm²). The six anterolateral thigh deep fascia flaps ranged from 7 cm × 6 cm to 14 cm × 9 cm in size (average, 71.8 ± 29.1 cm²). The thicknesses of skin ranged from 25 mm to 40 mm (average, 32.5 ± 4.8 mm), and the thicknesses of the deep fascia flaps ranged from 2 mm to 3 mm (average, 2.5 ± 0.5 mm). After the operation, the blood supply of the deep fascia flap was normal in all cases. The second‐stage skin grafts of most patients survived completely. The skin graft in one case was partially necrotic and healed after a dressing change. No infection occurred. At follow‐up (average, 16.3 ± 6.9 months), there was only a linear scar and no loss of sensation at the donor site of each patient. According to the outcome satisfaction scale, the outcome satisfaction score ranged from 6 to 8 (average, 7.2 ± 0.9), all of which were satisfactory. Apart from one patient who reported mild pain, all the other patients reported no pain. Three typical cases are presented in this article.ConclusionsThe free anterolateral thigh deep fascia flap, which is suitable for reconstruction of soft tissue defects in the hand, can provide very good outcomes both functionally and aesthetically.     

胫前动脉穿支螺旋桨皮瓣接力腓动脉终末前穿支螺旋桨皮瓣修复足踝部创面

目的探讨胫前动脉穿支螺旋桨皮瓣接力腓动脉终末前穿支螺旋桨皮瓣修复足踝部创面的疗效。方法2014年10月-2018年10月,收治18例足踝部创面患者。男12例,女6例。年龄8~56岁,平均32.8岁。致伤原因:交通事故伤11例,高处坠落伤3例,重物砸伤4例。创面部位:足背部9例,足跟4例,外踝5例。受伤至皮瓣修复时间7~34 d,平均19 d。创面范围6.0 cm×2.5 cm^11.0 cm×6.0 cm。采用大小为6 cm×3 cm^18 cm×7 cm的腓动脉终末前穿支螺旋桨皮瓣修复足踝部创面,其供区以胫前动脉穿支螺旋桨皮瓣(8 cm×3 cm^16 cm×6 cm)修复。结果术后1例腓动脉终末前穿支螺旋桨皮瓣出现瘀血肿胀,经对症处理后成活。其余皮瓣均顺利成活,供受区创面均Ⅰ期愈合。18例患者均获随访,随访时间6~15个月,平均12.5个月。末次随访时,两皮瓣外形、色泽、质地和厚度与受区基本一致,供区仅遗留线性瘢痕。腓动脉终末前穿支螺旋桨皮瓣两点辨别觉为10~12 mm,平均11 mm。根据美国矫形足踝协会(AOFAS)评分评价,获优15例、良3例,优良率为100%。结论应用胫前动脉穿支螺旋桨皮瓣接力腓动脉终末前穿支螺旋桨皮瓣修复足踝部创面,不需要牺牲主干血管,还能避免供区植皮,踝关节功能恢复满意。     

股前外侧皮瓣修复伴有骨外露的四肢皮肤软组织缺损

目的探讨游离股前外侧皮瓣修复伴有骨外露的四肢皮肤软组织缺损的临床效果。方法对62例伴有骨外露的四肢皮肤软组织缺损患者进行皮瓣移植,缺损面积6 cm×4 cm~25 cm×15 cm。术前、术中彻底清创受区,切取股前外侧皮瓣修复创面,处理血管危象。结果 62例均获得随访,时间6~12个月。出现血管危象6例,经及时处理后皮瓣恢复血液循环5例,皮瓣坏死1例,成功率为98.39%。结论股前外侧皮瓣供区隐蔽,简便实用,可用于伴有骨外露的四肢皮肤软组织缺损修复。     

Pedicled chimeric sensitive fasciocutaneous anterolateral thigh (ALT) and vastus lateralis muscle (VLM) flap for groin defect reconstruction: A case report

The anterolateral thigh (ALT) flap is one of the most commonly used flap worldwide, as both free flap and pedicled local flap. Here, we report the use of a pedicled chimeric sensitive ALT and vastus lateralis muscle (VLM) flap in a patient with a 12 cm × 8 cm contaminated soft tissue defect of the right inguinal region with exposed femoral vessels. The flap was harvested based on two perforators, one musculocutaneous and one pure muscular, each nourished separately a sensitive fasciocutaneous component and a vastus lateralis muscle component, respectively. The muscle part was tailored to wrap around the exposed vascular structures, while the innervated skin and fascia component of the flap provided a tension‐free closure of the wound. The post‐operative course was uneventful and the patient was discharged at 1 week post‐operative. Even though it requires technical skills and experience in perforator dissection, we believe that the pedicled chimeric sensitive ALT and VLM flap may be one of the best solutions in case of exposed femoral vessels in contaminated wounds.     

Flow-through嵌合ALTP急诊修复四肢Gustillo III C型损伤

目的探讨Flow-through嵌合股前外侧穿支皮瓣(ALTP)急诊一期修复四肢Gustillo III C型损伤的临床疗效。方法2010年1月至2017年12月,采用Flow-through嵌合ALTP急诊修复四肢Gustillo III C型损伤患者17例。其中男16例,女1例;年龄19~55岁,平均32.4岁。创面范围16 cm×8 cm^45 cm×30 cm。旋股外侧动脉降支Flow-through吻合受区动脉以重建肢体血供,股外侧肌瓣填塞深部死腔,皮瓣和筋膜瓣覆盖浅表创面。供区皮肤直接闭合6例,腹部取皮植皮11例。结果术后采用门诊结合微信、电话随访,时间5~60个月,平均21.8个月。皮瓣成活15例,2例失败并截肢。6例采用皮瓣和筋膜瓣修复,11例采用皮瓣、筋膜瓣和肌瓣修复。术后4例皮瓣一期愈合;11例患者皮瓣边缘出现坏死,其中1例换药后瘢痕愈合,其余10例患者二期植皮愈合。所有患者供区未出现并发症。结论急诊Flow-through嵌合ALTP在重建肢体血供的同时实现创面三维立体修复,是修复四肢Gustillo III C型损伤的有效方法之一。     

Reconstruction of foot and ankle defects with a superthin innervated anterolateral thigh perforator flap

Background: An anterolateral thigh (ALT) perforator flap can be thinned to an extent to which it is vascularised only by the subdermal plexus. This study presents an innervated flap thinning technique and its application for dorsal foot and ankle resurfacing.

Methods: A superthin innervated ALT perforator flap was used to repair the dorsal foot and ankle of 12 patients. The perforators were classified according to their variations in the adipose layer, and the corresponding microdissection technique was then applied. The branch of the lateral femoral cutaneous nerve and its accompanying vessels were adopted to construct a sensory flap.

Results: The flap thickness before defatting, which was measured immediately after flap elevation, ranged from 25–45?mm. The average flap thickness after defatting was 4.55?mm (range =?3–6?mm). A total of 11 flaps completely survived, and one flap presented superficial necrosis within a small area (2?cm ×2?cm) in the distal part of the flap. No further flap revision or defatting procedures were required for these patients during an average follow-up period of 16.5 months (range =?10–24 months). In the transferred flap, protective sensibility existed in all cases, and the static two-point discrimination was 13–16?mm.

Conclusions: The superthin innervated ALT perforator flap may be considered as an ideal strategy for foot and ankle reconstruction.     

股前外侧皮瓣游离移植修复下肢及足部皮肤软组织缺损的临床应用

目的 探讨股前外侧皮瓣游离移植修复下肢及足部软组织缺损的临床疗效。方法 选取2014年4月至2015年5月间,使用股前外侧皮瓣游离移植治疗下肢及足踝部软组织缺损的8例患者。术前通过B超及CT血管造影（computed tomography angiography, CTA）定位穿支血管的位置,术中对比血管定位位置后进行血管蒂分离。皮瓣切取面积为15 cm×15 cm～25 cm×15 cm。本组患者由于受区感觉神经缺损,均未进行受区感觉神经的修复。术后随访3个月以上,观察患者皮瓣外观及功能。结果 8例患者中,7例患者皮瓣术后存活,皮瓣对患处覆盖良好并有较好的外观及功能。1例患者术后第2天出现动脉危象,行探查术后再次出现静脉危象导致皮瓣部分坏死,清除坏死皮瓣组织,进行植皮换药后伤口愈合良好。结论 股前外侧皮瓣游离移植是游离皮瓣修复下肢及足踝部皮肤缺损中的经典术式,不仅可以减少患者的供区损伤,受区也可以得到良好的功能修复,但是在治疗过程中必须注意神经功能恢复及患肢的骨性功能恢复。     

游离削薄股前外侧皮瓣修复手腕部软组织缺损

目的探讨游离削薄型股前外侧皮瓣修复手腕部较大面积软组织缺损的临床效果方法首先对手腕部创面控制感染，减少分泌物，术中彻底清创，对受区血管状况做出判断，保证吻合血管质量，其次切取股前外侧皮瓣后，断蒂前修薄皮瓣至浅筋膜层，一般保留穿支血管周围1．5～2．0cm血管袖组织，可仅保留1支穿支血管。皮瓣移植修复创面后密切观察血供，及时处理血管危象：结果临床应用19例，移植皮瓣均成活，其中2例手术后24h出现血液循环危象，经及时处理后恢复皮瓣血液循环。结论削薄型股前外侧皮瓣厚度适宜，供区隐蔽、简便实用，可用于手腕部创面缺损修复，尤其适用于较大面积及肌腱、血管、神经外露创面的修复