Li Hai, Deng Chengliang, Wei Zairong, Jin Wenhu, Nie Kaiyu, Tang Xiujun, Wang Dali, Chang Shusen, Li Shujun
Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563000, P.R.China.
Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563000,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Oct 15;31(10):1245-1249. doi: 10.7507/1002-1892.201703048.
To evaluate the effectiveness of anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap for repairing extremities soft tissue defect.
Between January 2014 and January 2017, 24 patients with extremities soft tissue defects were treated by anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap. There were 15 males and 9 females, with a median age of 33.5 years (range, 5-64 years). Wounds located in upper limb in 8 cases, complicated with radial styloid fracture in 1 case, extensor tendon exposure in 3 cases, and brachioradialis muscle tendon exposed in 1 case. Wounds located in lower extremity in 16 cases, complicated with calcaneal or metatarsal, phalangeal fractures in 4 cases, Achilles tendon departure in 1 case, toe long extensor tendon and flexor digitorum longus tendon exposed in 8 cases. The wound area ranged from 8 cm×5 cm to 18 cm×12 cm. According to wound size, anterolateral thigh perforators were detected by conventional ultrasound Doppler (2-5 perforators). The irregular wounds were decomposed into multiple parts and the leaf number (2-4 leaves) of polyfoliate flap depended on the part number of the wound. The flap area ranged from 9 cm×6 cm to 20 cm×14 cm, and the largest area of single leaf was 24 cm×6 cm. The vascular pedicle length ranged from 7 cm to 12 cm. The foliate flap area with protecting pedicle ranged from 5 cm×3 cm to 7 cm×5 cm.
All the flaps survived, and no vascular crisis occurred. All the patients were followed up 2-28 months (mean, 9 months). Sinus occurred in 1 case of calcaneal fracture after flap repair, and the sinus was healed after 3 months by conventional dressing. All the flaps were thin and had a good texture. Healing of soft tissue was found in 5 patients with fracture. The wrist and ankle plantar flexion and dorsiflexion function of recipient site were normal in all patients.
It is safe and reliable to repair the extremities soft tissue defect with anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap. And it is one of the ways to reduce the vascular crisis of the anterolateral thigh free perforator flap.
评估股前外侧多叶穿支皮瓣加带蒂单叶皮瓣修复四肢软组织缺损的疗效。
2014年1月至2017年1月，对24例四肢软组织缺损患者采用股前外侧多叶穿支皮瓣加带蒂单叶皮瓣治疗。其中男15例，女9例，年龄中位数33.5岁（5～64岁）。上肢创面8例，合并桡骨茎突骨折1例，伸肌腱外露3例，肱桡肌肌腱外露1例。下肢创面16例，合并跟骨或跖骨、趾骨骨折4例，跟腱断裂1例，趾长伸肌腱和趾长屈肌腱外露8例。创面面积8 cm×5 cm～18 cm×12 cm。根据创面大小，采用传统超声多普勒探测股前外侧穿支（2～5支）。不规则创面分解为多个部分，多叶皮瓣叶数（2～4叶）根据创面部分数而定。皮瓣面积9 cm×6 cm～20 cm×14 cm，单叶最大面积24 cm×6 cm。血管蒂长度7 cm～12 cm。带蒂单叶皮瓣面积5 cm×3 cm～7 cm×5 cm。
所有皮瓣均成活，未发生血管危象。所有患者随访2～28个月（平均9个月）。皮瓣修复后1例跟骨骨折患者出现窦道，经常规换药3个月后愈合。所有皮瓣均较薄，质地良好。5例骨折患者软组织愈合。所有患者受区腕关节及踝关节跖屈、背伸功能正常。
股前外侧多叶穿支皮瓣加带蒂单叶皮瓣修复四肢软组织缺损安全可靠，是减少股前外侧游离穿支皮瓣血管危象的方法之一。
