股前外侧肌皮瓣修复足踝侧方组织缺损

Objective To explore the long-time clinical results and effection of free anterolateral thigh musculocutaneous flap for repairing the complex defects involving lateral or medial malleolar of the ankle and heel,especially for reconstructing stability of the ankle joints. Methods Thirteen patients with complex tissue defects,involving lateral or medial malleolar of the ankle and heel,were treated by free anterolateral thigh fasciomusculocutaneous flap.The fascia lata which was involved in the flap was fixed with the adjacent tissue of the recipient area.The descending branches of the lateral circumflex femoral vessels were anastomosed with the vessels in the recipient area.The largest area of the flap was 20 cm × 12 cm.The ankle joint was fixed in functional position with plaster in the early 3 months post-operatively.The following time ranged from 1.5 years to 20 years.The stability of the ankle joint were evatuated with the patients' objective feeling and clinical symptoms and imaging study.Results The stability of the ankle should be protected by external fixation in the early 3 months postoperatively,and was restored at 6 months usually.In all cases,ten cases were followed over 10 years,six cases were followed over 6 years,three cases were followed over 15 years.Though radiological discovering suggesting traumatic esteoarthritis exited in 3 cases with a follow-up more than 5 years,the clinical manifestations were fair and no one need undergo arthredesis. Conclusion Using ant erolateral thigh musculocutaneous flap for reconstructing the complex defects involving lateral or medial malleolar of the ankle and heel repairing stability of the joint and ovoiding off early arthrodosis of the joint is one of the favorable choice,especially for the teen-agers.     

股前外侧肌皮瓣修复足踝侧方组织缺损

Objective To explore the long-time clinical results and effection of free anterolateral thigh musculocutaneous flap for repairing the complex defects involving lateral or medial malleolar of the ankle and heel,especially for reconstructing stability of the ankle joints. Methods Thirteen patients with complex tissue defects,involving lateral or medial malleolar of the ankle and heel,were treated by free anterolateral thigh fasciomusculocutaneous flap.The fascia lata which was involved in the flap was fixed with the adjacent tissue of the recipient area.The descending branches of the lateral circumflex femoral vessels were anastomosed with the vessels in the recipient area.The largest area of the flap was 20 cm × 12 cm.The ankle joint was fixed in functional position with plaster in the early 3 months post-operatively.The following time ranged from 1.5 years to 20 years.The stability of the ankle joint were evatuated with the patients' objective feeling and clinical symptoms and imaging study.Results The stability of the ankle should be protected by external fixation in the early 3 months postoperatively,and was restored at 6 months usually.In all cases,ten cases were followed over 10 years,six cases were followed over 6 years,three cases were followed over 15 years.Though radiological discovering suggesting traumatic esteoarthritis exited in 3 cases with a follow-up more than 5 years,the clinical manifestations were fair and no one need undergo arthredesis. Conclusion Using ant erolateral thigh musculocutaneous flap for reconstructing the complex defects involving lateral or medial malleolar of the ankle and heel repairing stability of the joint and ovoiding off early arthrodosis of the joint is one of the favorable choice,especially for the teen-agers.     

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.     

股前外侧肌皮瓣修复小腿截肢残端软组织缺损

目的 探讨股前外侧肌皮瓣修复小腿截肢残端软组织缺损,保留小腿长度或膝关节以利于假肢装配.方法 2013年4月-2016年11月,应用股前外侧肌皮瓣对小腿截肢残端软组织缺损进行修复4例,其中游离肌皮瓣3例,带蒂肌皮瓣1例.患者均为男性,截肢肌创面位于小腿近端,年龄8~48岁,平均20岁,创面面积7.0 cm×6.0 cm^25.0 cm×10.0 cm.一期清创后二期修复,肌皮瓣面积13.0 cm×10.0 cm^28.0 cm×12.0 cm,保留胫骨长度5.2~9.4 cm.结果 肌皮瓣全部成活,1例肌皮瓣边缘出现浅表感染经换药处理后愈合,供区无并发症.所有患者随访12~37(平均19)个月,末次随访时皮瓣血运好、质地柔软、耐磨.皮瓣感觉恢复程度:S22例, S31例,S3+1例. 6 min步行测试:Ⅳ级2例,Ⅲ级2例;Stanmore运动分级:V级2例,Ⅳ级2例.结论 股前外侧肌皮瓣是修复小腿截肢残端软组织缺损的理想皮瓣.     

股前外侧皮瓣在肢体组织缺损修复中的几点改进

目的 提高应用股前外侧皮瓣治疗肢体软组织缺损的临床效果和成功率. 方法 根据修复的需要,将股前外侧皮瓣的结构模式发展为分叶肌皮瓣并将其肌瓣用于功能重建,采用皮瓣旋转、血管-筋膜蒂增加蒂长度.临床应用股前外侧皮瓣51例,股前外侧分叶肌皮瓣28例,其中4例肌皮瓣用于功能重建,股外侧肌肌瓣2例,股前外侧肌皮瓣2例,共修复肢体皮肤软组织缺损和功能重建87例. 结果 术后移植的皮瓣和肌皮瓣全部成活83例,部分成活1例,坏死3例.Ⅰ期愈合49例;Ⅱ期愈合22例;感染16例,感染伤口最终愈合时间2～15个月.肌瓣加皮片者质地硬韧,皮片有色素沉着.用于动力重建的肌瓣随访6～14个月,肌力2～4级.结论 股前外侧皮瓣可制成多种结构模式的肌皮瓣以增加血管蒂长和瓣-蒂长度,增大覆盖面积,是治疗肢体皮肤软组织缺损的理想方法 .     

股前外侧肌皮瓣修复四肢软组织缺损

目的探讨应用股前外侧肌皮瓣移植修复四肢严重创伤所致的软组织缺损及感染创面的临床疗效。方法应用吻合血管的股前外侧肌皮瓣移植修复四肢软组织缺损及感染创面12倒,肌皮瓣面积最大12cm-22cm,最小8cm-8cm。结果12例移植肌皮瓣全部成活,经1～5年随访,软组织缺损区修复良好,无明显臃肿,肌皮瓣感觉部分恢复。结论股前外侧肌皮瓣血供丰富,血管蒂长,可切取面积大,适合修复四肢严重创伤所致的软组织缺损及感染创面。     

修薄股前外侧皮瓣联合阔筋膜修复手和足部复合组织缺损

目的 探讨修薄股前外皮瓣联合同侧阔筋膜条游离修复手和足背部复合性组织缺损的临床效果. 方法 根据创面的大小切取不带筋膜且修薄的股前外侧皮瓣,并将阔筋膜根据肌腱缺损的长度切取一定的长度和宽度,外翻对边缝合使呈管状,经过一定时间和强度的牵张,在手、足保持一定的位置后,将其与伸肌腱远、近端以一定的张力进行显微技术缝合,皮瓣游离后与受区血管、神经进行吻合.供区行中厚皮植皮打包.自2008年10月至2012年2月共治疗8例,手部5例,缺损肌腱16条;足部3例,缺损肌腱13条.皮肤缺损范围:13 cm×6 cm～16 cm×11 cm,切取皮瓣的面积为:12 cm×6cm～19cm×13 cm. 结果 本组8例,随访6～12个月,皮瓣全部成活,质地外观好.两点辨别觉为8 ～ 11mm.供区植皮全部成活.肌腱修复疗效按中华医学会手外科学会手部肌腱修复后评定标准:优3指、2趾,良7指、5趾,可4指、4趾,差2指、2趾.手腕部活动度(中立位法):56°-0°-32°.示、中、环、小指掌指关节活动范围:70°-5°-0°,近侧指间关节:80°-10°-0°,远侧指间关节60°-15°-0°;足踝部活动度:45°-0°-26°.跖趾关节屈伸活动度35°-0°-40°. 结论 实施一期修薄的股前外侧皮瓣联合同侧阔筋膜游离修复手和足背侧复合性组织缺损,缩短手术时间及疗程,手和足背伸功能恢复满意,外形美观.     

修薄股前外侧皮瓣游离移植修复足踝部软组织缺损

目的 探讨修薄股前外侧皮瓣修复足踝部软组织缺损的方法及临床效果.方法 2007年3月至2010年6月,采用修薄股前外侧皮瓣游离移植修复足踝部软组织缺损12例,切取皮瓣面积为15.0 cm× 8.0 cm～7.5 cm×5.2cm.先确定皮瓣穿支血管部位,沿皮瓣外侧切开皮肤、皮下组织,在阔筋膜浅层显露穿支后,逆行向旋股外侧动脉降支主干解剖至所需血管蒂长度.以穿支血管为中心,向四周由浅及深削除皮下脂肪,在皮瓣周缘可将皮下脂肪完全削去,仅保留真皮层.皮瓣周缘厚度修薄前约2.5 cm,修薄后约0.4 cm.结果 12例修薄皮瓣全部成活.供、受区创面愈合良好,术后随访3～ 18个月,皮瓣质地优良,外观良好不臃肿,不需二次修薄手术,游离皮瓣两点辨别觉为8.0～10.0 mm.结论 修薄股前外侧皮瓣外形质地优良,不需再次手术整形,对供区创伤小,是修复足踝部软组织缺损的理想方法.     

股前外侧皮瓣修复足跟软组织缺损

足跟部因创伤引起的皮肤缺损,跟骨外露,顽固性溃疡及踝部附近的瘢痕挛缩,是修复重建外科的一个难点,传统的疗法难以奏效。我院于1986年以来,采用股前外侧皮瓣     

游离股前外侧穿支皮瓣或隐动脉穿支皮瓣修复足踝部软组织缺损

目的 探讨利用游离股前外侧穿支皮瓣或隐动脉穿支皮瓣修复足踝部软组织缺损的效果及手术技术.方法 2006年8月至2012年4月,对足踝部软组织缺损患者25例,创面范围4.0cm×5.5 cm～11.0 cm×23.0 cm.其中,足背软组织缺损采用游离股前外侧穿支皮瓣修复20例,足底软组织缺损采用游离隐动脉穿支皮瓣修复5例.结果 术后25例皮瓣全部成活.术后随访3～ 50个月,平均(18.0±0.8)个月.皮瓣修复后外形大部满意,皮瓣末梢二点辨别觉为10～22 mm,股前外和隐动脉穿支皮瓣组术后3个月随访,恢复S2+以上感觉分别为13/20和5/5例.结论 股前外穿支皮瓣修复足背软组织缺损较合适,隐动脉穿支用于修复足底软组织缺损.避免受区二次手术整形,重视皮瓣供区处理.负压封闭引流技术对开放性损伤导致创面的皮瓣成活有明显促进作用.     

股前外侧KISS皮瓣修复多个手指背侧软组织缺损

目的探讨股前外侧KISS皮瓣移植修复多个手指背侧软组织缺损的手术方法和临床效果。方法2014年1月至2019年6月,共收治7例多个手指背软组织缺损,其中累及3指者1例,4指者6例。一期手术通过设计手部创面,将多指并指后采用股前外侧KISS皮瓣移植修复,供区直接缝合关闭;二期手术分指同时皮瓣修薄整形。术后定期门诊、电话随访,观察皮瓣的外观、质地、功能及供区情况。结果术后皮瓣全部成活,皮瓣及供区伤口一期愈合,无血管危象发生。7例均获随访3~24(平均12.5)个月,皮瓣色泽好,质地柔软,弹性较好,经二期手术分指后皮瓣修薄整形,外形美观。供区肢体仅留一线形瘢痕,对关节功能无影响。结论通过合理的创面设计,选用供区损伤小、供瓣区能直接缝合的股前外侧KISS皮瓣移植修复多个手指背侧软组织缺损,是一种简单、有效的治疗方法。     

腓骨骨皮瓣组合股前外侧皮瓣修复小腿复合组织缺损

目的 探讨腓骨骨皮瓣与股前外侧皮瓣组合移植修复严重小腿软组织缺损并骨缺损的临床效果.方法 应用腓骨骨皮瓣与股前外侧皮瓣串联或并联组合移植,修复严重小腿软组织缺损并骨缺损36例.新鲜无菌创面10例,晚期感染创面26例.创面面积25 cm×18 cm～45 cm×13 cm,平均36 cm×16 cm,股前外侧皮瓣切取范围12 cm×13 cm～32 cm×18 cm,腓骨骨皮瓣切取范围2.0 cm×1.5 cm～18.0 cm×16.0 cm,腓骨切取长度10～24 cm.并联移植30例,串联移植6例,急诊手术5例,亚急诊手术5例,择期手术26例.结果 36例全部成功,35例获得随访,随访时间1～3年.术后发生动脉危象1例,静脉危象2例.移植组织全部成活34例,2例并联腓骨皮瓣部分坏死,行皮片移植后愈合.修复创面一期愈合32例,二期愈合4例,愈合时间12～28d,腓骨移植骨愈合时间3～6个月.应用Enneking评分23～28分,平均26分,供区无功能障碍.结论 腓骨骨皮瓣与股前外侧皮瓣组合移植修复小腿软组织缺损并骨缺损可使复杂创面修复一期完成,虽难度大风险高,但仍是一种理想的治疗方法.     

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.     

股前外侧双叶穿支皮瓣修复手部创面

目的：探讨股前外侧双叶穿支皮瓣修复手部创面的方法和疗效。方法2011年1月-2012年10月对9例手部创面采用游离股前外侧双叶穿支皮瓣修复,其中手部两处创面7例,另2例为洞穿性缺损。急诊修复创面桥接血管重建患肢血供1例,延期修复创面8例。结果本组9例皮瓣全部成活,术后随访3～6个月,供区外观仅为线状瘢痕,功能无明显影响。2例手部洞穿性缺损修复后外观满意,功能欠佳;其余7例创面修复后皮瓣质地柔软,外观稍臃肿,功能满意。结论股前外侧双叶穿支皮瓣可一次修复手部两个创面或通过拼接修复一处较大创面,而供区常可以直接缝合,优点明显。