Flow-through嵌合ALTP急诊修复四肢Gustillo III C型损伤

目的探讨Flow-through嵌合股前外侧穿支皮瓣(ALTP)急诊一期修复四肢Gustillo III C型损伤的临床疗效。方法2010年1月至2017年12月,采用Flow-through嵌合ALTP急诊修复四肢Gustillo III C型损伤患者17例。其中男16例,女1例;年龄19~55岁,平均32.4岁。创面范围16 cm×8 cm^45 cm×30 cm。旋股外侧动脉降支Flow-through吻合受区动脉以重建肢体血供,股外侧肌瓣填塞深部死腔,皮瓣和筋膜瓣覆盖浅表创面。供区皮肤直接闭合6例,腹部取皮植皮11例。结果术后采用门诊结合微信、电话随访,时间5~60个月,平均21.8个月。皮瓣成活15例,2例失败并截肢。6例采用皮瓣和筋膜瓣修复,11例采用皮瓣、筋膜瓣和肌瓣修复。术后4例皮瓣一期愈合;11例患者皮瓣边缘出现坏死,其中1例换药后瘢痕愈合,其余10例患者二期植皮愈合。所有患者供区未出现并发症。结论急诊Flow-through嵌合ALTP在重建肢体血供的同时实现创面三维立体修复,是修复四肢Gustillo III C型损伤的有效方法之一。

Emergency repair of Gustillo III C limb extremities with free Flow-through chimeric anterolateral thigh perforator flap

Objective To explore the clinical effects of a single stage reconstruction and revascularization using a free Flow-through chimeric anterolateral thigh perforator (ALTP) flap in Gustillo III C limb injuries.Methods From January, 2010 to December, 2017, 17 patients with Gustillo III C injury of extremities were repaired with Flow-through chimeric ALTP in emergency surgeries. The patients were 16 males and 1 female with mean age of 32.4 (19-55) years. The size of wounds ranged from 16 cm×8 cm-45 cm×30 cm. The injured arteries were Flow-through anastomosed with the descending branch of the lateral circumflex femoral artery to regain blood flow. The deep dead space was filled with vastus lateralis flap, and the skin flap and fascia flap were used for superficial covering. The donor site was closed directly in 6 patients, simultaneous skin grafts were applied in 11 patients.Results The followed-up time ranged 5 to 60 (average 21.8) months, and conducted by clinic visits and by telephone or WeChat interviews. Fifteen flaps survived, and 2 flaps failed with limb amputated. Six patients were repaired with skin and fascia flaps and 11 patients received flaps comprising the skin, fascia and vastus lateralis muscle. Four flaps healed in stage I. Partial necrosis were observed in 11 flaps. Of which, 1 healed by change of dressing and 10 healed by skin grafting. No complications occurred in donor site in all patients.Conclusion The Flow-through chimeric ALTP flap can be used in stage I reconstruction of the blood supply of limbs and meanwhile achieve the 3-D repair of defects. It is one of the reliable methods in the reconstruction of Gustillo III C injuries in the extremities.