Yang Lin, Liu Hongjun, Zhang Wenzhong, Song Guoxun, Xia Shicong, Zhang Naichen, Gu Jiaxiang, Yuan Chaoqun
Department of Hand and Foot Microsurgery, Clinical Medicine College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou Jiangsu, 225001, P.R.China.
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Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Oct 15;31(10):1240-1244. doi: 10.7507/1002-1892.201705022.
To explore the effectiveness of modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis in treatment of soft tissue defects in the middle and lower segments of the leg.
Between March 2011 and June 2015, 15 cases with skin and soft tissue defects in the middle and lower segments of the legs were treated. There were 9 males and 6 females, aged 22-48 years (mean, 32.6 years). Of whom, 8 patients caused by traffic accidents, 5 by machine twist, and 2 by crash injury of heavy object. The mean interval from injury to admission was 82.6 hours (range, 2 hours to 1 week). The area of defect ranged from 13 cm×9 cm to 23 cm×16 cm. After primary debridement and vaccum sealing drainage treatment, the defects were repaired with modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis. The size of flap ranged from 15 cm×10 cm to 25 cm×15 cm. The donor sites were sutured directly or repaired with the skin grafts. The pedicle division was done at 4 weeks after operation.
After operation, venous crisis occurred in 1 case and distal skin necrosis in 2 cases which was healed by dressing change. The other tissue flaps survived successfully and wounds healed by first intention. All skin grafts at donor site survived after operation, and primary healing of wound was obtained. All patients were followed up 6-24 months (mean, 13 months). All flaps were characterized by soft texture, satisfactory appearance, and restoring the protective sensation. Moreover, the two-point discrimination ranged from 15 to 28 mm (mean, 19.5 mm) at 6 months after operation. The function of both lower extremities were normal without obvious contracture of scar at donor site.
Modified free anterolateral thigh perforator flap, with little damage in donor site, a reliable blood supply by making a cross-bridge microvascular anastomosis with pretibial or posterior tibial blood vessel on normal leg, is a reliable alternative method for repairing soft tissue defects with the main vessels of serious injury in the middle and lower segments of the leg.
探讨桥式微血管吻合的改良股前外侧穿支皮瓣修复小腿中下段软组织缺损的疗效。
2011年3月至2015年6月，收治15例小腿中下段皮肤软组织缺损患者。男9例，女6例，年龄22～48岁，平均32.6岁。其中，交通事故致伤8例，机器绞伤5例，重物砸伤2例。受伤至入院时间平均82.6小时（范围2小时至1周）。缺损面积为13 cm×9 cm至23 cm×16 cm。经一期清创及负压封闭引流处理后，采用桥式微血管吻合的改良股前外侧穿支皮瓣修复缺损。皮瓣面积为15 cm×10 cm至25 cm×15 cm。供区直接缝合或植皮修复。术后4周断蒂。
术后1例发生静脉危象，2例出现远端皮肤坏死，经换药愈合。其余组织瓣均顺利成活，创面一期愈合。供区植皮术后全部成活，伤口一期愈合。所有患者随访6～24个月，平均13个月。所有皮瓣质地柔软，外形满意，保护性感觉恢复。术后6个月两点辨别觉为15～28 mm，平均19.5 mm。双下肢功能正常，供区无明显瘢痕挛缩。
改良游离股前外侧穿支皮瓣供区损伤小，与正常小腿胫前或胫后血管行桥式微血管吻合血供可靠，是修复小腿中下段主要血管严重损伤软组织缺损的可靠替代方法。
