旋股外侧动脉降支多叶组织瓣修复多指(趾)软组织缺损

目的 探讨应用旋股外侧动脉降支为蒂的一蒂多叶组织瓣一次修复多指(趾)软组织缺损的方法和临床效果.方法 2005年6月至2008年12月,收治8例多指(趾)软组织缺损患者,男5例,女3例;年龄22～38岁,平均27.6岁.设计以旋股外侧动脉降支的肌皮穿支或肌间隙穿支为蒂形成股前外侧穿支皮瓣,带股外侧皮神经前支;以股外侧肌肌支、股直肌肌支、股中间肌肌支、远端肌间隔支为分叶瓣,依受区缺损面积及各指(趾)蹼间距切取各组织瓣,在肌瓣上植全厚皮,一次修复手(足)部创面.结果 术后8例患者均未发生血管危象,植皮均成活.全部病例获6个月～3年(平均10.5个月)随访,修复各创面外形均良好,无臃肿,植皮处轻微挛缩.肌瓣植皮处恢复保护性感觉,各皮瓣两点辨别觉约8～10 mm.修复1例左足一至三趾软组织缺损病例,术后患足无疼痛及不适,负重行走正常;修复7例手部缺损病例,按中华医学会手外科学会上肢部分功能评定试用标准进行评价:优1例,良4例,可2例,优良率71%.结论 以旋股外侧动脉降支为蒂多叶组织瓣能一次修复多指(趾)软组织缺损,仅需吻合一组血管,无需行分指及整形手术,是修复多指(趾)软组织缺损的理想方法.     

游离股前外侧筋膜瓣移植与重塑植皮修复手、足皮肤软组织缺损

目的探讨股前外侧筋膜瓣游离移植成活后重塑植皮修复手、足软组织缺损的临床效果。方法2000年1月～2005年7月,应用吻合血管的远端带有观察岛状皮瓣的股前外筋膜瓣移植,成活后7～10d行筋膜瓣肉芽重塑,游离植皮修复手部软组织缺损9例、足背软组织缺损2例,筋膜瓣面积8cm×15cm～10cm×22cm。结果11例吻合血管的筋膜瓣全部成活,重塑后植皮全部成活。所有患者术后获3～18个月随访,受区外形、功能恢复满意。结论以旋股外侧动脉降支为血管蒂的筋膜瓣,血管解剖恒定、蒂长、切取容易,成活后重塑植皮,瓣薄平整、外形功能好,适宜修复手、足软组织缺损创面。     

旋股外侧动脉降支与膝外上动脉双轴点皮瓣的临床应用

目的 报道旋股外侧动脉降支与膝外上动脉双轴点皮瓣修复膝关节周围软组织缺损的临床效果. 方法 以旋股外侧动脉降支与膝外上动脉为血管轴,髌骨外上缘为轴点,以旋股外侧动脉第一肌皮穿支为第二轴点设计皮瓣,修复膝部软组织缺损3例. 结果 3例皮瓣全部成活,质地外形满意. 结论 利用旋股外侧动脉降支-膝外上动脉双轴点皮瓣很大程度延长了血管蒂的长度,从而有效地扩大了皮瓣的适用范围.     

股前外侧穿支皮瓣加筋膜瓣修复手部两个软组织缺损

目的回顾性分析探讨股前外侧穿支皮瓣加筋膜瓣修复手部两个软组织缺损的临床疗效。方法 2010年1月至2016年1月,5例手部两个软组织缺损应用股前外侧穿支皮瓣加筋膜瓣修复,切取的穿支皮瓣加筋膜瓣近端为穿支皮瓣,远端为筋膜瓣。血管蒂与受区的血管行端端吻合,筋膜瓣行一期中厚网状游离植皮,皮瓣供区直接缝合。结果 1例筋膜瓣术后发生远端尖部小片植皮坏死,经2周换药处理逐渐自行愈合。所有的组织瓣全部成活。术后随访2.0～4.5年,平均3.5年,受区外形较好,供区没有发生明显的功能障碍。本组取得了满意的临床效果。结论股前外侧穿支皮瓣加筋膜瓣适宜修复手部两个软组织缺损。     

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.     

旋股外侧动脉降支皮瓣血流桥接手掌毁损血管重建血运的疗效分析

目的分析旋股外侧动脉降支皮瓣血流桥接手掌毁损血管重建血运的效果。方法 2014年12月-2015年12月,采用旋股外侧动脉降支皮瓣对11例手掌毁损伤创面进行修复并桥接手部缺损动脉,重建手指血运。对术后的外形功能随访。结果 11例皮瓣和手部组织全部成活,皮瓣供区创面直接闭合10例,1例皮瓣供区植皮修复。术后行超声多普勒检查证实桥接血管吻合良好,手部组织和皮瓣血运恢复良好,手部伤口供区Ⅰ期愈合,皮瓣恢复感觉,改善关节活动度。皮瓣质地、颜色、薄厚均较好,患者对皮瓣外形较为满意。结论采用旋股外侧动脉降支皮瓣血流桥接手掌毁损伤血管既可覆盖创面又可恢复血供,是目前重建手掌毁损伤血运的一种较理想方法 。     

股前外侧肌间隔肌腱瓣修复示指伸肌腱与软组织缺损一例

患者 女性，32岁。因右手示、中指绞扎伤1．5d入院。检查：右示指背侧从近侧与远侧指间关节之间接近环形软组织缺损，仅有约1．0cm宽掌侧皮肤完好，伴有伸指肌腱在Ⅳ区缺损与部分近节指骨外露。中指指尖软组织缺损伴末节指骨部分外露。急诊分两组手术：一组行手部清创术，用中指尺侧逆行指动脉岛状皮瓣修复中指残端创面；另一组切取对侧股前外侧肌间隔肌腱瓣，按切取吻合血管的阔筋膜瓣的方法显露旋股外侧血管降支，将降支血管游离至距髌骨20cm处时，以降支血管为轴切取2．5cm×6．0cm肌间隔瓣，     

带肌瓣的旋股外侧动脉降支穿支皮瓣修复合并死腔的小腿软组织缺损

目的探讨带肌瓣的旋股外侧动脉降支穿支皮瓣修复合并死腔的小腿软组织缺损的临床疗效。方法自2015年1月至2019年12月,对深圳市中西医结合医院手外科收治的12例合并死腔的小腿软组织缺损伤的患者,采用带肌瓣的旋股外侧动脉降支穿支皮瓣修复,皮瓣切取面积6.0 cm×6.0 cm～15.0 cm×8.0 cm,肌瓣体积5.0 cm×3.0 cm×3.0 cm～13.0 cm×3.0 cm×3.0 cm。皮瓣的穿支动脉与受区的胫前动脉或胫后动脉吻合,伴行静脉与受区胫前动脉或胫后动脉的伴行静脉吻合。术后定期随访。结果 12例皮瓣未发生血管危象,全部成活,伤口均无感染,一期愈合。随访6～18个月,皮瓣成活且外形良好,无臃肿、溃疡、骨髓炎发生,患肢功能恢复较满意。结论带肌瓣的旋股外侧动脉降支穿支皮瓣抗感染力强,能良好的填塞死腔,有效地预防伤口感染及骨髓炎的发生,临床效果好,是一种良好修复合并死腔的小腿软组织缺损的治疗方法。     

旋股外侧动脉斜支穿支皮瓣供区闭合方式探讨

目的探讨旋股外侧动脉斜支穿支皮瓣供区创面的闭合方式,以减少供区并发症。方法闭合创面方式包括:皮下潜行分离后直接拉拢缝合、皮下潜行分离后植皮修复、带蒂旋股外侧动脉降支穿支皮瓣转移修复以及带蒂旋髂浅动脉穿支皮瓣转移修复。缺损部位包括前臂及手背5例、小腿5例和足部8例。软组织缺损范围为4.0 cm×9.0 cm~10.0 cm×29.0 cm。斜支穿支皮瓣切取范围5.0 cm×11.0 cm~11.0 cm×33.5 cm。结果所有患者获随访1~6个月,皮瓣、皮片均完全成活,切口一期愈合。植皮患者残留1.5 cm瘢痕,直接缝合和穿支皮瓣修复者供区术后为线状瘢痕。髋膝关节活动自如,行走未见肌力减退。供瓣区留下不同程度感觉障碍区,植皮和穿支皮瓣修复者供区感觉麻木较明显,供区直接缝合者感觉障碍范围较小。结论旋股外侧动脉斜支穿支皮瓣供区直接缝合可降低皮瓣感觉障碍,对于面积较大供区可采用邻近区域穿支皮瓣修复,以达到最佳外观。     

股前外侧阔筋膜瓣联合股外侧肌肌腱瓣移植修复足背软组织缺损

2002年6月至2007年5月,我们应用旋股外侧动脉降支肌皮穿支或肌间隙皮支为血供的股前外侧阔筋膜瓣,联合切取股外侧肌肌腱瓣行吻合血管移植,一期修复足背血管、肌腱与皮肤缺损5例,取得了满意效果.     

吻合血管的阔筋膜瓣游离移植及皮片修复手部创伤性缺损

目的　考察应用吻合血管的阔筋膜瓣游离移植 ,联合皮片修复手部软组织缺损的临床效果。方法　共行手术 8例 ,切取的阔筋膜瓣最大 6cm× 1 6cm ,最小 3cm× 8cm。结果　移植的阔筋膜瓣和皮片全部成活 ,取得了预期的效果。结论　以旋股外侧动脉降支为血管蒂的阔筋膜瓣 ,血管解剖恒定 ,蒂长 ,切取容易 ,且瓣较薄 ,适宜修复手部软组织缺损     

游离阔筋膜瓣移植修复小腿软组织和主要血管 缺损

目的：总结吻合血管的阔筋膜瓣移植修复小腿软组织和主要血管缺损的临床应用结果。方法：2000年9月至2008年12月,应用阔筋膜瓣移植修复5例（男4例,女1例）小腿软组织和主要血管缺损,用其携带的旋股外侧动脉降支行桥式吻合,同时修复受区肢体主要血管缺损。患者年龄19～48岁,平均34岁。切取阔筋膜瓣范围6.5cm×9cm～9cm×18cm,Ⅰ期行中厚网状游离植皮,股部供区直接缝合。结果：阔筋膜瓣全部成活,手术顺利。随访时间11个月～3.5年,平均2.5年,未发现明显的供区功能障碍,供区与受区外形较好,受区小腿经临床观察与Doppler检查,胫前和胫后动脉通畅。结论：阔筋膜瓣以旋股外侧动脉降支为血供,血运丰富、血管解剖恒定、血管蒂长以及切取容易,而且较薄,适宜修复小腿软组织和主要血管缺损。     

旋股外侧动脉降支侧支皮瓣修复下肢软组织缺损

目的探讨基于三维重建技术的旋股外侧动脉降支侧支皮瓣修复下肢软组织缺损的临床效果。方法 2009年3月-2010年1月,收治7例足、踝及胫前区皮肤软组织缺损患者。男6例,女1例;年龄6～51岁。交通事故伤4例,重物压伤3例。损伤部位:足部2例,踝部2例,胫前区3例。伤后至入院时间为8 h～40 d,平均20 d。创面伴骨、肌腱等组织外露,皮肤软组织缺损范围12 cm×7 cm～20 cm×14 cm。入院后对合并伤进行对症处理,4～16 d后手术。术前先行皮瓣数字化三维重建,并行皮瓣设计。术中切取大小为15 cm×9 cm～22 cm×16 cm的旋股外侧动脉降支侧支皮瓣游离移植修复缺损。供区直接缝合。结果术后皮瓣均成活,创面及供区切口均Ⅰ期愈合。患者均获随访,随访时间6～12个月。皮瓣外形、质地较好,恢复保护性感觉,能满足日常生活需要。踝关节功能满意,背伸19～22°,跖屈30～36°,正常行走。供区无明显瘢痕形成,肢体无异常。结论旋股外侧动脉降支侧支皮瓣血供可靠,操作简便,对供区影响小,术前三维重建设计可提高手术成功率,可作为修复下肢软组织缺损的理想选择之一。     

Thoracodorsal artery perforator flap: a versatile alternative for various soft tissue defects

Thoracodorsal artery perforator (TDAP) flap is a relatively new member of the perforator flap family. The objective of this study is to describe the use of pedicled and free TDAP flaps for various soft tissue defects. Fifteen patients underwent soft tissue reconstruction using 16 TDAP flaps. Twelve pedicled flaps were used for axillary, breast, and shoulder regions. Four free flaps were used for cheek, popliteal, hand, and foot reconstruction. The flaps were harvested based on the perforators, which were preoperatively located at or close to a point 8 cm below the posterior axillary fold and 2 cm behind the lateral border of the latissimus dorsi muscle. Early, late, major, and minor complications were documented. In 13 of the 16 flaps, perforators from the thoracodorsal artery were found in the circle 3 cm in diameter, centered on the anatomic landmark. Three other perforators were found outside this circle. One flap loss was considered the only major complication. Minor complications occurred in 12.5% of flaps. Although the vascular anatomy can be variable, free and pedicled TDAP flap is a versatile option in soft tissue reconstruction.     

以旋股外侧动脉降支供血的游离组织瓣修复小腿软组织缺损

目的 探讨以旋股外侧动脉降支逆行转位供血的游离组织瓣修复严重的小腿创伤伴软组织缺损的临床效果.方法 对小腿软组织损伤严重且无可携带游离组织瓣的血管,以旋股外侧动脉降支的远端为蒂,将其近端与游离组织瓣的动脉吻接,大隐静脉或小隐静脉与游离组织瓣的动脉伴行静脉吻接,2004年10月至2009年12月,采用该方法修复小腿软组织缺损36例,其中携带背阔肌肌皮瓣15例,股前外侧皮瓣12例,胸脐皮瓣9例.结果 36例游离皮瓣(肌皮瓣)均顺利成活,无一例出现血管危象,随访6个月至2.5年,皮瓣外形及功能恢复均较满意.结论 在小腿无可供吻合的血管时,应用以旋股外侧动脉降支逆行转位供血的游离组织瓣修复小腿软组织缺损,是一种切实有效的手术方法.

Abstract：

Objective To investigate the therapeutic effect of free tissue flap anastomosed with reverse descendant branch of lateral femoral circumflex artery for severe soft tissue defect at leg. Methods The severe soft tissue defect at leg, without any vessels for anastomosis of free tissue flap, was reconstructed with free tissue flap, which was anastomosed with proximal end of descendant branch of lateral femoral circumflex artery and great saphenous vein. From Oct. 2004 to Dec. 2009, 36 cases were treated with 15 cases of latissimus dorsi musculocutaneous flaps, 12 cases of anterolateral femoral flaps,and 9 cases of thoracoumbilicus flaps. Results All the 36 free flaps survived completely. The patients were followed up for 6 months to 2. 5 years with good cosmetic results. Conclusions It is effective and practical to repair the severe soft tissue defects at legs with the reverse descendant branch of lateral femoral circumflex artery to carry the free flaps.     

Repair of severe composite tissue defects in the lower leg using two different cross-leg free composite tissue flaps

This article reports 2 cross-leg free composite tissue flaps for repairing the severe composite tissue defects in lower leg without suitable adjacent recipient vasculature for microvascular anastomosis. The osseous myocutaneous flap of ilium and tensor fascia lata pedicled with ascending branch of lateral femoral circumflex vessels and the osseous muscle flap of scapula and latissimus dorsi pedicled with subscapular vessels were performed, respectively, to reconstruct the bone and soft-tissue defects in the lower leg of 2 patients. Both donor vessels were the posterior tibial artery and great saphenous vein from the contralateral lower leg. The legs and the bone flaps were immobilized by an external fixator. The periods of pedicle division were 43 and 67 days, respectively, after transplantation. Both flaps survived after pedicle division and the patients regained the ability to walk. There were no such complications as joint stiffness or donor site morbidity except for a linear scar. The 2 cross-leg free composite tissue flaps were optional methods for salvaging limbs that were otherwise nonreconstructable. But the indication for cross-leg free-tissue flap should be limited strictly.     

应用吻合血管的阔筋膜瓣联合游离皮片移植修复手指软组织缺损的经验介绍

目的介绍应用吻合血管的阔筋膜瓣联合游离皮片移植修复手指软组织缺损的经验。方法临床应用５例９指。阔筋膜瓣的面积最大为６ｃｍ×９ｃｍ,最小为２．５ｃｍ×７．０ｃｍ。结果移植的阔筋膜瓣全部成活,植于其上的中厚皮片除２例有小块坏死外,其余也全部成活。术后随访１～４年,除１指的近节指间关节、１指的掌指关节屈曲受限外,其余手指伸屈活动正常,效果满意。结论该筋膜瓣以旋股外侧动脉降支为供血来源,血管解剖恒定,血管蒂长,切取容易。移植后的筋膜皮瓣较薄,适于修复手指软组织缺损。     

Versatility of the free anterolateral thigh flap: clinical experience in a series of 20 patients

The main nutrient vessel of the anterolateral thigh flap is the perforator originating from the descending branch of the lateral circumflex femoral artery (LCFA). It supplies a large area of skin on the anterolateral aspect of the thigh. We present the experience of 20 consecutive anterolateral thigh flaps used for a variety of soft tissue defects. Fourteen flaps were used for lower leg reconstruction, four in the head and neck, and the remaining two in the hand. The largest flap was 30᎗ cm. All flaps survived except two which had partial skin necrosis, but the underlying adipose tissue survived and was grafted. Reexploration was needed for one patient in whom a thrombus blocking the vein was removed, and the flap survived completely. The anterolateral thigh flap has the advantage of a long vascular pedicle, large-caliber vessels, availability of a large skin flap area, and suitability as a flow-through flap.