旋股外侧动脉降支穿支皮瓣显微削薄的临床应用

目的　探讨旋股外侧动脉降支穿支皮瓣显微削薄的临床应用效果。 方法　自2014年5月至2016年1月，笔者单位收治26例手足部皮肤软组织缺损患者。采用旋股外侧动脉降支穿支皮瓣修复创面，创面面积（外伤患者为扩创后面积）为6 cm×4 cm～15 cm×10 cm，切取皮瓣面积为8 cm×5 cm～21 cm×8 cm。皮瓣断蒂前在放大镜下根据II级穿支走行，保留II级穿支及其周围1 cm左右深筋膜组织，切除深筋膜及部分浅筋膜的脂肪组织，保留2～3 mm的真皮下脂肪，观察皮瓣血供良好后断蒂移植受区。 结果　25例皮瓣完全成活。1例皮瓣远端出现约2 cm×1 cm大小坏死，经换药2周愈合。皮瓣中央呈锥状臃肿，15例II期行中央臃肿修薄术。均获6～20个月随访，皮瓣外观满意，质地薄而柔软,感觉麻木。供区残留线状瘢痕。 结论　旋股外侧动脉降支穿支皮瓣可I期去除大部分深筋膜及部分浅筋膜组织、必要时II期去除皮瓣中央臃肿组织，减少II期皮瓣整形次数及手术难度。

Clinical application of micro-debulking perforator flap based on descending branch of the lateral circumflex femoral artery

Objective　To investigate the effect of clinical application of the micro-debulking perforator flap based on the descending branch of the the lateral circumflex femoral artery.　Methods　Between May 2014 and January 2016, 26 cases of tissue defects of the hands and feet were repaired with the micro-debulking perforator flaps based on the descending branch of the lateral circumflex femoral artery. The soft tissue defect area ranged from 6 cm×4 cm to 15 cm×10 cm. The flaps ranged from 8 cm×5 cm to 21 cm×8 cm. According to the second-perforator course，the perforator and the deep fascia about 1 mm around it were preserved under a magnifying glass before cutting off the pedicle. The peripheral fat tissue was removed to the utmost extent. 2~3 mm thick circumferential fat tissues of the flaps were preserved. The flaps were transplanted to recipient site after excellent blood perfusion of the flaps was checked.15 cases are swelled obviously postoperatively, which was managed by re-open one edge of the flaps to remove the fatty tissue.　Results Twenty-five flaps survived completely. Only one flap suffered partial margin necrosis with a size of 2 cm ×1cm, which was healed after dressing change for two weeks. Fifteen cases with centrally-located bulk was thinned in a second phase. Patients were followed up for 6 to 20 months. The appearance of flaps was satisfactory and the texture was thin and soft, and the sensation was numb.only linear scars could be seen in the donor site. Conclusions The perforator flap based on the descending branch of lateral circumflex femoral artery can withstand the removal of most of the deep fascia and superficial fascia tissue. If necessary, the central fat tissue of the flaps was removed in asecond phase, reducing the number of plastic surgery and the difficulty of operation.