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.

Repair soft tissue defects of multiple-fingers/toes with multiplefoliated flap pedicled by descending branch of lateral circumflex femoral artery

Ohjeetive To investigate the methods and effects of multiplefoliated flap pedicled by descending branch lateral circumflex femoral artery to repair soft tissue defects of multiplefingers/toes. Methods From June 2005 to December 2008, 8 patients with soft tissue defects of multiple-fingers/toes were repaired with multiplefoliated flap pedicled only by descending branch lateral circumflex femoral artery. Five of them are male and three of them are female, with average age of 27.6 years (range, 22-38 years). Anterolateral thigh perforator flaps with lateral femoral cutaneous nerve pedicled by musculocutaneous perforator or spatium iutermusculare perforator of descending branch of lateral circumflex femoral artery, muscle flaps pedicled by branches of vastus lateralis muscle, rectus femoris muscle, vastus intermedius muscle and distal spatium intermusculare perforator of it respectively were designed to repair soft tissue defects of mnltipie-fingers/toes, at the same time muscle flaps were covered by skin graft, so the soft tissue defects were repaired in one time. Results No vascular crisis happened in eight cases and all skin grafts survived. All cases were followed up from 6 months to 3 years (the average was 10.5 months). The contour of repaired area was good except that the skin grafts had little contracture. Two point discrimination (2-PD) was 8-10 mm of every flap and protective feeling was recovered by skin grafts of every muscle flap. There were no pain and malaise repaired left toe, the second and third toes, weight-bearing and walking were normal. In seven cases of hand soft tissue defects, 1 case was excellent, 4 cases were well and 2 cases were good according to upper extremity function evaluation criteria of Chinese Medical Society for the Surgery of the Hand, the rate of good was 71 percent. Conclusion Soft tissue defects of multiple-fingers/toes can be repaired by multiplefoliated flap only pedicled by descending branch of lateral circumflex femoral artery. Its advantages are only one pair of vessels was anastomosesd and there are no second and plastic operation. It is a good method to repair soft tissue defects of multiple-fingers/toes.