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...

Microsurgical thinned anterolateral thigh perforator flap to repair soft tissue defects of foot and ankle

Objective To explore method and clinical effect of microsurgical thinned anterolateral thigh perforator flap to repair soft tissue defects of foot and ankle.Methods From March 2017 to January 2022,totally 20 patients with soft tissue defects of ankle joint were treated with micro-thinning anterolateral perforator flap for free transplantation,included 13 males and 7 females,aged from 22 to 58 years old with an average of (36.45±12.36) years old. The size of flap ranged from 8.0 cm×5.0 cm to 20.0 cm×12.0 cm. Before operation,perforating vessels on the anterolateral thigh region were detected and marked with a portable Doppler detector. For the defect width less than 8 cm,11 patients were repaired with a single flap. For the defect width more than 8 cm,the wound could not be sutured directly,and the lobulated flap technique was used in 9 patients,the width was converted to length,and the donor site was closed directly. Under the microscope,all flaps were thinened in a stepwise manner from the center of the pedicle to the periphery. After operation,survival of the flap,the shape,texture,sensory function recovery were observes,and recovery of foot function was evaluated by Maryland foot function evaluation standard.Results All 20 patients with microsurgical thinned anterolateral thigh perforator flaps were survived. Venous crisis occurred in 1 patient due to subcutaneous hematoma,after removal of the hematoma,the crisis was relieved and the flap survived successfully. The wounds in the donor and recipient sites healed well,and only linear scars left in the donor sites. Twenty patients were followed up for 3 to 26 months after operation,good shape of flaps without bloated,and good texture. The two-point discrimination of free flaps ranged from 9.0 to 16.0 mm,and the protective sensation was restored. The ankle flexion and extension function recovered well and patients could walk normally. According to Maryland foot function evaluation standard,8 patients got excellent result,10 patients good and 2 middle.Conclusion Microsurgical thinned anterolateral thigh perforator flap is an ideal method to repair soft tissue defects in functional area of foot and ankle,with good appearance and texture of the flap,no need for re-plastic surgery,reduced hospitalization costs,and less donor site damage.