股前外侧皮瓣修复足踝部带蒂皮瓣坏死创面的临床疗效

doi:10.3760/cma.j.cn101202-20230416-00105

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摘要目的探讨股前外侧皮瓣在修复足踝部带蒂皮瓣术后坏死创面中的应用效果。方法病例系列报告。纳入2009年3月—2021年12月解放军联勤保障部队第九二〇医院收治的28例足踝部带蒂皮瓣术后坏死创面患者的临床资料,其中男16例、女12例,年龄7~55岁（34.7±13.0）岁。28例中,胫后动脉穿支螺旋桨皮瓣坏死16例、腓动脉穿支螺旋桨皮瓣坏死9例、腓肠神经营养血管皮瓣坏死2例、外踝上穿支皮瓣坏死1例,皮瓣坏死创面大小为4.5 cm×4.0 cm~25.0 cm×7.5 cm,均采用股前外侧皮瓣进行修复。术中记录皮瓣大小和血管蒂长度,术后观察皮瓣愈合情况及并发症,并采用Thankappan皮瓣外观满意度自评分评价皮瓣外观,温哥华瘢痕量表评估供区瘢痕情况。结果本组28例皮瓣切取与移植均顺利,皮瓣大小5.0 cm×4.5 cm~16.5 cm×10.0 cm,血管蒂长度5.1~11.5（8.3±2.2）cm。供区直接缝合27例,植皮1例。术后发生皮瓣静脉危象2例,经探查后部分坏死1例、完全成活1例;发生皮下血肿2例、边缘感染1例,对症处理后均好转;其余皮瓣完全成活。患者术后获随访6~16（11.4±2.8）个月。术后发生皮瓣臃肿18例（64.3%,18/28）,其中16例行修薄术;并发瘢痕增生1例。末次随访时,皮瓣外观满意度自评分5~8（6.4±0.9）分,其中良24例、可4例;供区瘢痕评分4~9（5.7±1.7）分。结论股前外侧皮瓣是修复足踝部带蒂皮瓣术后坏死创面的安全、有效的方法,但术后大多发生皮瓣臃肿,需要二期修薄。

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	何晓清
	杨曦
	石岩
	段家章
	董凯旋
	徐月仙
	王腾
	徐永清

关键词 ：游离组织瓣, 带蒂皮瓣, 足踝部损伤, 软组织缺损

Abstract：Objective This study aimed to estimate the outcomes of anterolateral thigh flap for foot and ankle defects secondary to pedicled flap failure. Methods A case series report was conducted. Twenty-eight patients with foot and ankle defects secondary to pedicled flap failure from March 2009 to December 2021 were reviewed in the 920th Hospital of PLA Joint Logistic Support Force. The patients were 16 males and 12 females, ranging from 7 years old to 55 years old, with an average of (34.7±13.0) years. Among the 28 patients, 16 patients had posterior tibial artery perforator propeller flaps necrosis, nine patients had peroneal artery perforator propeller flaps necrosis, two patients had sural neurocutaneous flaps necrosis, and one patient had lateral malleolus perforator flap necrosis. The defects secondary to pedicled flap failure ranged from 4.5 cm×4.0 cm to 25.0 cm×7.5 cm. All defects were reconstructed with anterolateral thigh flap. The flap size and pedicle length were recorded during surgery. The flap healing and complications were recorded after surgery. At the last follow-up, the Thankappan flap appearance satisfaction self-score was used to evaluate the flap appearance, and Vancouver scar scale (VSS) was utilized to evaluate the scar formation of donor site. Results All flaps were harvested and transferred uneventfully. The flap size ranged from 5.0 cm×4.5 cm to 16.5 cm×10.0 cm. The pedicles were 5.1-11.5 (8.3±2.2) cm. The donor site was sutured directly in 27 patients and skin graft in one patient. Venous compromise occurred in two patients, one patient became partial necrosis and one patient of complete survival after exploration. Two patients were occurred with subcutaneous hematoma and one patient experienced a local infection. The other flaps survived uneventfully. The patients were followed up 6-16 (11.4±2.8) months. Flap bulking occurred in 18 patients and scar hyperplasia in one patient. The debulking procedures were performed in 16 patients. At the last follow-up, the flap appearance satisfaction was 5-8 (6.4±0.9) points. Twenty-four patients were good, and four patients were fair. The VSS was 4-9 (5.7±1.7) points. Conclusion Anterolateral thigh flap is a safe and effective method for repairing the defects secondary to pedicled flap failure. However, many anterolateral thigh flaps are bulking and need to accept the debulking procedure in the second stage.

Key words： Free tissue flaps Pedicled flap Foot and ankle injury Soft tissue defect

收稿日期: 2023-04-16

基金资助:云南省创伤骨科临床医学中心项目（ZX20191001）; 昆明医科大学应用基础研究联合专项（202101AY070001-298,202201AY070001-288,202201AY70001-292）; 联勤保障部队第九二〇医院院内科技计划（2019YGB05,2020YGD08,2020YGC02）; 云南省骨科与运动康复临床医学研究中心项目（202102AA310068）

通讯作者: 徐永清,Email：xuyongqingkm@163.net

引用本文:

何晓清, 杨曦, 石岩, 段家章, 董凯旋, 徐月仙, 王腾, 徐永清. 股前外侧皮瓣修复足踝部带蒂皮瓣坏死创面的临床疗效[J]. 中华解剖与临床杂志, 2023, 28(10): 657-661.
He Xiaoqing, Yang Xi, Shi Yan, Duan Jiazhang, Dong Kaixuan, Xu Yuexian, Wang Teng, Xu Yongqing. Anterolateral thigh flap for reconstruction of foot and ankle defects secondary to pedicled flap failure. Chinese Journal of Anatomy and Clinics, 2023, 28(10): 657-661.

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