CAJ | 학술논문

目的探讨大面积股前外侧皮瓣的设计、切取方法及修复创面的疗效. 方法依据股前外侧皮瓣穿支血管的解剖特点设计皮瓣.切取皮瓣时保留一支较粗大的肌支或源血管的终末支,在皮瓣近端或远端选取一支口径适宜的穿支,将两者吻合以扩大血管供血范围,皮瓣皮血管为肌皮穿支型的供吻合的穿支自肌肉穿出点切断,皮瓣皮血管为肌间隙穿支或直接皮动脉型的广泛游离供吻合的肌皮穿支.自2006年5月至2012年5月,采用该术式临床应用于四肢大面积皮肤缺损的创面修复28例,术中测量穿出肌肉浅出处切断穿支的血管口径,术后观察皮瓣成活情况并随访供区有无并发症出现. 结果 18例皮血管为肌皮穿支型的皮瓣自肌肉穿出点切断供吻合的穿支,术中测量该处血管口径为1.3 ～1.8 mm,平均1.45 mm,均可用于吻合.28例28块皮瓣全部成活,皮瓣面积22.0 cm×15.0 cm ～42.0 cm×14.0 cm.其中2例皮血管为肌皮穿支型的皮瓣术后发生动脉危象,为血肿压迫吻合口并形成血栓,清除血肿后重新吻合,皮瓣成活.无感染病例发生,皮瓣受区与供区均一期愈合,未发现皮瓣皮缘坏死.28例全部获得随访,随访时间4 ～ 13个月,平均8个月,皮瓣供区未见明显塌陷畸形、肌肉坏死、肌力减退和肌疝等,皮瓣外观平整、颜色接近正常、质地好. 结论采取吻合穿支的手术方式可切取大面积的股前外侧皮瓣,用于创面的修复,手术安全、有效.
목적 탐토대면적고전외측피판적설계、절취방법급수복창면적료효. 방법 의거고전외측피판천지혈관적해부특점설계피판.절취피판시보류일지교조대적기지혹원혈관적종말지,재피판근단혹원단선취일지구경괄의적천지,장량자문합이확대혈관공혈범위,피판피혈관위기피천지형적공문합적천지자기육천출점절단,피판피혈관위기간극천지혹직접피동맥형적엄범유리공문합적기피천지.자2006년5월지2012년5월,채용해술식림상응용우사지대면적피부결손적창면수복28례,술중측량천출기육천출처절단천지적혈관구경,술후관찰피판성활정황병수방공구유무병발증출현. 결과 18례피혈관위기피천지형적피판자기육천출점절단공문합적천지,술중측량해처혈관구경위1.3 ～1.8 mm,평균1.45 mm,균가용우문합.28례28괴피판전부성활,피판면적22.0 cm×15.0 cm ～42.0 cm×14.0 cm.기중2례피혈관위기피천지형적피판술후발생동맥위상,위혈종압박문합구병형성혈전,청제혈종후중신문합,피판성활.무감염병례발생,피판수구여공구균일기유합,미발현피판피연배사.28례전부획득수방,수방시간4 ～ 13개월,평균8개월,피판공구미견명현탑함기형、기육배사、기력감퇴화기산등,피판외관평정、안색접근정상、질지호. 결론 채취문합천지적수술방식가절취대면적적고전외측피판,용우창면적수복,수술안전、유효.
Objective To approach the design and clinical application of large anterolateral thigh flap and its effect in wound repair.Methods The flaps were designed according to the anatomical features of perforating branches in the anterolateral thigh flaps.When a flap was chipped,a thick branch or a terminal branch of original vessel was reserved,another suitable perforating branch was selected in the proximal or distal end of the flap,and then the two vessels were anastomosed to enlarge the range of blood supply.If the vessel pedicle of a flap was a musculocutaneous perforating branch,the perforating branch of anastomosis was cut at out-point of muscle.If the vessel pedicle of a flap was a intermusclar branch or a direct skin artery,the perforating branch of anastomosis was cut widely.From May 2006 to May 2012,the technique was applied in 28 patients with large skin defect of limbs.The diameters of perforating branches obtained at out-point of muscles were measured during surgery.The survival of flaps was observed after surgery and complications in donor sites were checked during follow-ups.Results There were 18 flaps whose vessel pedicle were musculocutaneous perforating branches.The branches were cut at outpoint of muscles.The diameters of these vessels were measured during surgery.They ranged from 1.3 mm to 1.8 mm with an average of 1.45 mm.All of the vessels could be anastomosed.All 28 flaps survived.All flaps survived.The areas of the flaps ranged from 22 cm × 15 cm to 42 cm × 14 cm.Artery crisis happened in 2 flaps whose vessel pedicle were musculocutaneous perforating branches.The second look operation found that the areas of artery anastomosis of perforating branches and vessel pedicles were compressed by hematoma and thrombus formed.The 2 flaps survived after the hematoma was cleared away and the vessels were reanastomosed.There were no infections.Both the donor and recipient site healed by first intention with no necrosis of flap margin.All 28 patients were followed up by 4-13 months with an average of 8 months.There were no apparent collapse deformities,muscle necrosis,declines of muscle strength and muscle hernia in the donor sites.The appearance of flaps was flat,the color was close to normal and the quality was fine.Conclusion It is a safe and effective method to repair wound surface by large anaterolateral thigh flap obtained by the modus operandi of perforating branch anastomosis.