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《中国美容医学》[ISSN:1008-6445/CN:61-1347/R]

卷:

期数:

2023年2期

页码:

56-60

栏目:

出版日期:

2023-02-10

文章信息/Info

Title:

Clinical Effect of Anterolateral Thigh Flap with End to Side Anastomosis Through Transverse Incision in Repairing Soft Tissue Defects Around Large Joints of Extremities

文章编号:

1008-6455(2023)02-0056-04

作者:

杨 辰; 王振中; 刘 路; 殷耀斌; 杨 勇

(北京积水潭医院手外科 北京 100035 )

Author(s):

YANG Chen; WANG Zhenzhong; LIU Lu; YIN Yaobin; YANG Yong

(Department of Hand Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

关键词:

股前外侧皮瓣; 移植; 软组织缺损; 血管吻合; 显微外科手术; 创面修复

Keywords:

anterolateral femoral fl ap;  transplantation;  soft tissue defect;  vascular anastomosis;  microsurgery;  wound repair

分类号:

R622

文献标志码:

A

摘要:

目的：探讨采用横行切口进行血管端侧吻合的股前外侧皮瓣修复四肢大关节周围大面积软组织缺损的临床疗效。方 法：选择2017年6月-2021年3月笔者科室收治的15例因瘢痕或肿瘤切除后四肢大关节周围大面积软组织缺损的患者为研究对 象，术前多普勒超声确定皮瓣穿支部位，术中测量关节周围软组织缺损面积为7 cm×13 cm～10 cm×23 cm，均采用游离股 前外侧皮瓣移植修复软组织缺损。皮瓣血管与主干血管进行端侧吻合，将吻合口的切口方向从以往的纵行切口改为横行切 口，以减少主干血管的损伤并利于吻合。术后定期随访12～26（18.7±3.4）个月，记录皮瓣愈合情况、关节功能、皮瓣 供区愈合情况、血管吻合处的B超检查结果。结果：术后皮瓣全部成活，皮瓣供区均愈合，均未发生血管或皮瓣相关并发 症；术后1个月、3个月和12个月随访时各关节的总主动活动度（TAM）分别为（45.33±22.31）°、（64.33±27.04）°和 （76.67±32.66）°，术后时间越长，关节活动度越好，差异有统计学意义（P＜0.05）。术后12个月，患侧TAM为健侧的 65.47% ，关节活动功能改善满意；皮瓣疗效满意度评定，总分6～9分，平均6.8分，疗效均为满意；术区血管B超检查，所有 主干动脉和皮瓣营养动脉血流通畅，皮瓣动脉管径(1.72±0.14)mm，血液流速(11.5±1.6)cm/s。结论：应用横行切口进行 端侧吻合的股前外侧皮瓣移植治疗四肢大关节周围大面积软组织缺损，可减少受区组织损伤、降低血管吻合难度，皮瓣成活 率高，术后肢体功能恢复良好，为四肢大关节周围软组织缺损的修复提供了一种可靠易行的方案。

Abstract:

Objective To investigate the clinical effect of anterolateral femoral flap with transverse incision for end-to-side anastomosis in the repair of large soft tissue defects around the large joint of the extremities. Methods From June 2017 to March 2021,15 patients with large soft tissue defects around large joints of limbs after scar or tumor resection were admitted to our department.Doppler ultrasound was used to determine the location of the perforating branch preoperatively.The sizes of soft tissue defect were from 7 cm×13 cm to 10 cm×23 cm intraoperatively,and the defect was repaired by free anterolateral femoral fl ap.In order to reduce the damage of main blood vessels and facilitate anastomosis,the fl ap vessels were anastomosed to the main blood vessels by end-to-side anastomosis,with the incision direction of main blood vessels changed from longitudinal to transverse direction.Regular follow-up was performed to record the fl ap healing,joint function,donor site healing,and the results of ultrasound examination of the vessels. All patients were followed up for 12 ～ 26 (18.7±3.4) months. Results All the fl aps survived,the donor sites of fl aps healed well,and no vascular or fl ap-related complications occurred.The total active motion (TAM) at 1,3 and 12 months after operation were (45.33±22.31)°,(64.33±27.04)° and (76.67±32.66)°, respectively.The longer the following time,the better the TAM,the diff erence was statistically signifi cant (P ＜0.05). 12 months after operation,TAM of the aff ected side was 65.47% of that of the healthy side,with a good joint function.The satisfaction score of fl ap was evaluated with a total score of 6 - 9 points and an average of 6.8 points.Ultrasonography was performed,all the main arteries and nutrient arteries of the fl ap have good blood fl ow. The arterial diameter of the fl ap was (1.72±0.14) mm,and the blood fl ow velocity was(11.5±1.6) cm/s. Conclusion Application of femoral anterolateral fl ap transplantation,with transverse incision of the main vessels,can reduce tissue damage,facilitate anastomosis,improve the survival rate of fl ap.The postoperative recovery of limb function is good.It is a reliable and feasible solution to repair large soft tissue defect around the large joint of limbs.

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更新日期/Last Update: 2023-03-06