受区吻合旋股外侧动脉降支的游离皮瓣修复小腿软组织严重缺损

目的 探讨受区吻合旋股外侧动脉降支的游离皮瓣修复小腿软组织严重缺损的临床疗效。方法 回顾性分析2008年10月—2015年2月唐山市第二医院手二科采用受区吻合旋股外侧动脉降支的游离皮瓣修复24例小腿软组织严重缺损患者的临床资料。其中男19例、女5例,年龄19～56岁(平均38.4岁);左侧10例,右侧14例;交通伤15例,矿石砸 伤8例,高处坠落伤1例。急诊手术行骨折外固定架固定、肢体血运重建,负压封闭式吸引术;二期行游离皮瓣移植覆盖创面,以吻合旋股外侧动脉降支逆行供血;三期行植骨内固定或骨延长术。软组织缺损8 cm×12 cm～22 cm×36 cm;切取皮瓣12 cm×15 cm～25 cm×40 cm,其中对侧股前外侧皮瓣12例,背阔肌皮瓣9例,胸脐皮瓣3例。通过对皮瓣愈合、皮瓣外形、皮瓣温度、皮瓣感觉、供区瘢痕等5个方面的评分对术后疗效进行评价。结果 24例皮瓣成活并保肢成功23例,伤口一期愈合;另1例因严重多重耐药菌感染行截肢。20例获得12～66个月随访(平均31个月),肢体可负重行走,足底有保护性感觉,皮瓣颜色好,外观无臃肿,未出现肢体创伤性软组织缺损及难治性感染等并发症,疗效评分7~10分,疗效满意。结论 利用受区吻合旋股外侧动脉降支的游离皮瓣能有效修复小腿创伤性软组织缺损,功能恢复良好,并发症少。

Application of free skin flap combined with the lateral circumflex femoral artery for the repair of soft tissue defects in the lower leg

Objective To discuss the treatment and clinical efficacy of applying free skin flap combined with the reversed descending branch of lateral circumflex femoral artery to repair soft tissue defects in the lower leg after trauma. Methods Clinical data of 24 patients with severe soft tissue defects of calf from October 2008 to February 2015 were analyzed retrospectively. All patients underwent soft tissue coverage surgery using the free flaps combined with the reversed descending branch of lateral circumflex femoral artery. There were 19 males and 5 females aged from 19-56 years (mean, 38.4 years). The causes of injury were traffic accident in 15 cases, ore crushing injury in 8 cases, and high falling injury in 1 case, with 10 patients suffering injury on the left side and 14 cases on the right side. Firstly, the fractures of limb were treated by external fixator following debridement, and after the legs were revascularized, vacuum sealing drainage was applied in emergency surgery. Secondly, the free flaps were transplanted and anastomosed with the descending branch of lateral circumflex femoral artery to cover the wound. Thirdly, bone graft and internal fixation were performed or bone lengthening was operated on patients. Sizes of the tissue defects were 8 cm×12 cm-22 cm×36 cm, and the flap sizes were 12 cm×15 cm-25 cm×40 cm. Among them, 12 patients were grafted with anterolateral thigh flap, 9 with latissimus dorsal myocutaneous flap, and 3 with thoracic umbilical flap. Finally, the postoperative curative efficacy was assessed from five aspects including flap healing, flap appearance, the temperature and sensation of flaps, and the scar. Results Altogether 23 limbs were survived, and the wounds healed by first intention; while the remaining 1 case suffered amputation due to severe infection with multidrug-resistant bacteria. Twenty patients were followed up for 12-66 months (mean, 31 months). Patients obtained nearly unaffected walking and weight-bearing function, with protective feeing in the feet. The flaps survived well, without overstaffed appearance. The score of curative effect score was 7-10. It turned out that the procedures were satisfactory. ConclusionsThe free flap anastomosed with the descending branch of lateral circumflex femoral artery can effectively repair the soft tissue defects in the lower leg.