旋股外侧动脉横支为蒂的股前外侧皮瓣重建肘部复合组织缺损的临床应用

目的 探讨以旋股外侧动脉横支为蒂的股前外侧皮瓣,游离移植修复肘部肱动脉伴皮肤软组织缺损的临床疗效.方法 2000年3月-2008年2月,对8例肘部肱动脉损伤伴皮肤软组织缺损的患者,急诊一期采用旋股外侧动脉横支为蒂的股前外侧皮瓣游离移植修复,同时用横支血管桥接缺损的肱动脉(3～7cm),皮瓣切取面积为12cm×6cm～20cm×10 cm.结果 8例肢体及皮瓣均顺利存活,术后随访10～21个月,肘部皮瓣无明显臃肿及瘢痕挛缩现象,肘关节屈伸活动度平均为105°(95°～125°),8例患侧肢体前臂远端尺、桡动脉搏动强度与健侧相同,B超显示患侧肱动脉血流与健侧基本相同.结论 切取股前外侧皮瓣时,如发现旋股外侧动脉降支有变异,可切取以旋股外侧动脉横支为蒂的股前外侧皮瓣,重建肘部肱动脉损伤和软组织缺损.

Clinical application of the anterolateral thigh flap pedicled on the transverse branch of the lateral femoral circumflex artery for reconstruction of composite defects of the elbow

Objective To reconstruct soft tissue defect of the elbow combined with brachial artery injury using anterolateral thigh flap that used the transverse branch of the lateral femoral circumflex artery as the vessel pedicle, and evaluate the clinical results. Methods Eight cases of brachial artery injury along with soft tissue defect at the elbow were treated between March 2000 and February 2008. Primary repair of the tissue defect was done by free transfer of the anterolateral thigh flap using the transverse branch of the lateral femoral circumflex artery as the vessel pedicle. The transverse branch of the lateral femoral circumflex artery was simultaneously inserted between the two ends of the injured brachial artery (3 to 7 cm defect). The areas of the skin defect ranged from 12 cm×6 cm to 20 cm×10 cm. Results Limbs and flaps of the 8 cases all survived. Postoperative follow up ranged from 10 months to 21 months. There were no obvious bulkiness and scar contracture of the tlaps. The average ROM of the elbows was 105°(95° to 125°). In all 8 cases, the pulse strength of the distal ulnar and radial arteries was the same as that of the uninjured side. Ultrasound detection of the brachial artery revealed blood flow of the injured side similar to that of at the uninjured fide. Conclusion When there exists vascular variation of the descending branch of the lateral femoral circumflex artery during dissection of the anterolateral thigh flap, the transverse branch of the hteral femoral circumflex artery can be used as the vessel pedicle of the flap. Made as a flow-through flap, this flap can be transferred to recommit soft tissue defects of the elbow combined with brachial artery defect.