CAJ | 학술논문

目的探讨应用Flow-through股前外侧游离皮瓣同期修复软组织和主干血管缺损的可行性与疗效. 方法 2003年5月至2012年2月共收治21例肢体严重创伤患者,男13例,女8例;年龄14 ～53岁,平均37.3岁.创伤部位:上肢4例,下肢17例.血管断裂并缺损14例,血管广泛挫伤并血栓形成7例.所有患肢均存在严重的软组织缺损合并主干血管损伤,且伴有不同程度的骨质、肌腱、血管或神经外露.肢体损伤严重程度评分为5～8分,平均5.8分.8例肢体远端血供差或完全消失的患者彻底清创后一期行Flow-through皮瓣移植术;13例血供部分存在但明显差于健侧的患者,根据清创后创面情况,6例直接行一期皮瓣移植术,7例行二期皮瓣移植术. 结果 21例患者术后获3～43个月(平均11.8个月)随访.所有患者均保肢成功,移植皮瓣全部存活,肢体远端血供良好,无血管危象发生.3例患者皮瓣边缘部分坏死,2例患者供区植皮后部分坏死,3例患者发生浅表感染,1例患者发生骨髓炎,均经处理后获改善. 结论 Flow-through股前外侧游离皮瓣技术可在修复创面的同时修复主干血管损伤,为严重开放性四肢创伤的治疗提供了一种可靠的方法.
목적 탐토응용Flow-through고전외측유리피판동기수복연조직화주간혈관결손적가행성여료효. 방법 2003년5월지2012년2월공수치21례지체엄중창상환자,남13례,녀8례;년령14 ～53세,평균37.3세.창상부위:상지4례,하지17례.혈관단렬병결손14례,혈관엄범좌상병혈전형성7례.소유환지균존재엄중적연조직결손합병주간혈관손상,차반유불동정도적골질、기건、혈관혹신경외로.지체손상엄중정도평분위5～8분,평균5.8분.8례지체원단혈공차혹완전소실적환자철저청창후일기행Flow-through피판이식술;13례혈공부분존재단명현차우건측적환자,근거청창후창면정황,6례직접행일기피판이식술,7례행이기피판이식술. 결과 21례환자술후획3～43개월(평균11.8개월)수방.소유환자균보지성공,이식피판전부존활,지체원단혈공량호,무혈관위상발생.3례환자피판변연부분배사,2례환자공구식피후부분배사,3례환자발생천표감염,1례환자발생골수염,균경처리후획개선. 결론 Flow-through고전외측유리피판기술가재수복창면적동시수복주간혈관손상,위엄중개방성사지창상적치료제공료일충가고적방법.
Objective To study the surgical outcomes of simultaneous limb salvage using flow-through anterolateral thigh flaps for severe extremity injuries involving soft tissues and major blood vessels. Methods From May 2003 to February 2012,21 cases of severe extremity injuries were treated in our department.They were 13 men and 8 women,aged from 14 to 53 years (average,37.3 years).There were 4 cases of upper limb injury,17 cases of lower limb injury,14 cases of vascular rupture and defect and 7 cases of massive vascular contusion and thrombosis.In all the injured limbs,severe soft tissue defects were associated with major arterial damages and more or less exposure of the bone,tendon,blood vessel and nerve.Their Mangled Extremity Severity Scores (MESS) ranged from 5 to 8 points (average,5.8 points).The one-stage flow-through flap graft was conducted following thorough debridement in 8 patients with poor or disappeared distal blood supply; of the 13 patients with partial blood supply,6 underwent one-stage flap graft directly and 7 had secondary flap graft according to the wound condition following debridement. Results The 21 patients were followed for 3 to 43 months (average,11.8 months).All the flaps survived and all the injured limbs were salvaged.The blood supply to the distal limb was fine in all cases without any vascular crisis.Necrosis at partial flap margins (3 cases),partial necrosis at the donor site (2 cases),superficial infection (3 cases) and osteomyelitis (one case) were handled until improvement. Conclusion The flow-through anterolateral thigh flap,which can repair soft tissue defects and major vascular injuries simultaneously,is one of the preferable methods in limb salvage for severely damaged extremities.