CAJ | 학술논문

目的探讨旋股外侧动脉降支多叶瓣修复手部多部位软组织缺损的手术方法和临床效果。方法对手部多部位软组织缺损15例，采用旋股外侧动脉降支多叶瓣修复，根据手部缺损情况设计股前外侧皮瓣，沿皮瓣穿支血管向远端继续解剖旋股外侧动脉降支，考虑好手部各缺损处间距，按需切取分叶穿支皮瓣、阔筋膜瓣、股直肌肌瓣、股外侧肌肌瓣、股中间肌肌瓣或旋股外侧动脉降支远端肌间隔瓣。形成以旋股外侧动脉降支为主干的一蒂多叶瓣，在肌瓣及阔筋膜瓣上植皮，一次修复手部多部位软组织缺损。结果术后无血管危象发生。修复各创面在肌瓣、阔筋膜瓣或旋股外侧动脉降支远端血管肌间隔上植皮均成活良好，外形无臃肿，植皮处恢复保护性感觉，供区创面愈合好，股四头肌肌力及膝关节屈、伸活动均正常。全部病例获得随访，随访时间6 ～ 20个月，平均8.7个月。按中华医学会手外科学会上肢部分功能评定标准：优3例，良9例，可3例，优良率80％。结论旋股外侧动脉降支多叶瓣能一次修复手部多部位软组织缺损，缩短手术时间及疗程，手部功能恢复良好，外形满意，是修复手部多部位软组织缺损的理想方法。
목적 탐토선고외측동맥강지다협판수복수부다부위연조직결손적수술방법화림상효과。방법대수부다부위연조직결손15례，채용선고외측동맥강지다협판수복，근거수부결손정황설계고전외측피판，연피판천지혈관향원단계속해부선고외측동맥강지，고필호수부각결손처간거，안수절취분협천지피판、활근막판、고직기기판、고외측기기판、고중간기기판혹선고외측동맥강지원단기간격판。형성이선고외측동맥강지위주간적일체다협판，재기판급활근막판상식피，일차수복수부다부위연조직결손。 결과 술후무혈관위상발생。수복각창면재기판、활근막판혹선고외측동맥강지원단혈관기간격상식피균성활량호，외형무옹종，식피처회복보호성감각，공구창면유합호，고사두기기력급슬관절굴、신활동균정상。전부병례획득수방，수방시간6 ～ 20개월，평균8.7개월。안중화의학회수외과학회상지부분공능평정표준：우3례，량9례，가3례，우량솔80％。 결론 선고외측동맥강지다협판능일차수복수부다부위연조직결손，축단수술시간급료정，수부공능회복량호，외형만의，시수복수부다부위연조직결손적이상방법。
Objective To introduction of perforator flaps, muscle flaps pedicled by descending branch of lateral circumflex femoral artery, method and their clinical application that multiple soft tissue defects of hand are repaire by muliplefoliated tissue flap only branch lateral circumflex femoral artery.Methods Fifteen patients with multiple soft tissue defects of hand were repaired muliplefoliated tissue flap only pedicled by descending branch lateral circumflex femoral artery. At first, the anterolateral thigh perforator flap was designed and harvested according to the soft tissue defects of hand, then the descending branch lateral circumflex femoral artery was dissected at the same time the segmented perforator flap, fascia lata flap,rectus femoris muscle flap, vastus lateralis muscle flap, vastus intermedius muscle flap and distal spatium intermusculare flap were harvested in need according to distance among soft tissue defects. The muliplefoliated tissue flap was harvested only pedicled by descending branch lateral circumflex femoral artery, at last muscle flaps and fascia lata flaps were covered by skin graft, so the multiple soft tissue defects of hand were repaired in one time. Results No vascular crisis happened. All skin grafts survived well, the contour of all repaired soft tissue defects was good and protective feeling was recovered by skin grafts of all flaps. All cases were got follow-up and the range was from 6 to 20 months (the average was 8.7 months). Wound of donor site healed well, muscle strength of quadriceps and motion of knee were normal. Three cases were excellent,nine cases were well and 3 cases were good, according to upper extremity function evaluation criteria of Chinese Medical Society for the Surgery of the Hand, the rate of good was 80 percent. Conclusion Multiple soft tissue defects of hand can be repaired by muliplefoliated flap only pedicled by descending branch of lateral circumflex femoral artery. Its advantages included reduction of operation time and treatment, good recovery of hand contour and function. It is a good method to repair multiple soft tissue defects of hand.