手持多普勒超声在股前外侧皮瓣修复足部缺损中的应用

目的　利用手持多普勒超声观察研究股前外侧皮瓣（anterolateral thigh flap，ALTF）穿支血管的体表位置与数量，为ALTF 设计提供依据。 方法　术前在髂前上棘与髌骨外上缘连线（α线），其中点（A点）与腹股沟韧带股动脉搏动点（B点）连线（β线），β线即为旋股外侧动脉降支的体表投影。应用手持多普勒超声于β线及以A点为中心半径为3 cm圆形区域内寻找皮穿支，予以标记，以穿支搏动最明显处设计股前外侧皮瓣。我科于2016.04-2019.09，临床应用8例，均为下肢软组织缺损，皮瓣最大21 cm×10 cm，最小8 cm×6 cm。 结果　股前外侧皮瓣皮穿支大部分位于A点周围，其中粗大的穿支均位于A点下外侧。本组皮瓣8例，7例全部成活，1例皮瓣远端部分表皮坏死，经换药后自行愈合。术后门诊随访5~12个月，皮瓣成活，外形及功能良好。 结论　术前应用手持多普勒超声，能有效定位股前外侧皮瓣可靠的穿支，从而提高皮瓣切取的准确性与安全性，减少手术时间。

Application of handheld Doppler ultrasound in repairing foot defect with anterolateral thigh flap

Objective　To provide reference for anterolateral thigh flap (ALTF ) design by using handheld Doppler ultrasound to observe the surface position and number of the ALTF perforating vessels.　Methods　Before the operation, line α was the connection between the anterior superior iliac spine and the upper superior patella. Line β was the connection between the point A and the pulsation point (B) of the pulse point of femoral artery under inguinal ligament, which was the surface projection of the descending branch of the lateral femoral circumflex artery. The handheld Doppler ultrasound was used to find the perforating branches in the circular area with the radius of 3 cm centered on the point A, and the anterior anterolateral thigh flaps were designed with the most obvious perforator pulsation. There was 8 cases of clinical applying in our department from Apr. 2016 to Sep. 2019, all of which were soft tissue defects of lower limbs, the largest flap size was 21cm × 10cm, the smallest 8 cm×6 cm.　Results　Most of the anterolateral thigh flaps were located around point A, and the thick perforators were located outside the point A. For 8 cases of flaps, 7 cases all survived, 1 case had partial epidermal necrosis at the distal end of the flap, and which healed after dressing change. After 5~12 months of outpatient follow-up, the flap survived well, the shape and function were good.　Conclusions　Preoperative application of handheld Doppler ultrasound can effectively locate the reliable perforating branch of the anterolateral thigh flap, thereby improving the accuracy and safety of flap removal and reducing the operation time.