CAJ | 학술논문

目的探讨穿支血管导航下超薄股前外侧皮瓣修复手部创面的临床应用.方法对7例手部皮肤缺损患者,皮肤缺损面积为5.5 cm×7.2 cm～ 10.0 cm×12.5 cm,术前用多普勒探测仪对股前外侧穿支血管进行探测,确定穿支血管的走向及穿出点的位置,精确切取股前外侧皮瓣并剔除多余的皮下脂肪,吻合穿支血管与受区动静脉重建皮瓣血液循环,大腿皮瓣供区直接闭合或部分植皮.结果 7例股前外侧游离皮瓣全部存活,1例皮瓣术后出现血管危象,手术探查发现动脉吻合口内有血栓形成,取出血栓后重新吻合血管后皮瓣存活,2例皮瓣术后部分皮缘出现淤黑、干性坏死,直接清创缝合创面.术后随访2个月至2年,平均11个月,手部皮瓣外观满意,7例皮瓣均无需二次整形,手功能恢复良好,大腿供区创面愈合好.按中华医学会手外科学会手功能评定标准评定:优4例,良2例,可1例.结论穿支血管导航下超薄股前外侧皮瓣修复创面是一种较理想的方法.
목적 탐토천지혈관도항하초박고전외측피판수복수부창면적림상응용.방법 대7례수부피부결손환자,피부결손면적위5.5 cm×7.2 cm～ 10.0 cm×12.5 cm,술전용다보륵탐측의대고전외측천지혈관진행탐측,학정천지혈관적주향급천출점적위치,정학절취고전외측피판병척제다여적피하지방,문합천지혈관여수구동정맥중건피판혈액순배,대퇴피판공구직접폐합혹부분식피.결과 7례고전외측유리피판전부존활,1례피판술후출현혈관위상,수술탐사발현동맥문합구내유혈전형성,취출혈전후중신문합혈관후피판존활,2례피판술후부분피연출현어흑、간성배사,직접청창봉합창면.술후수방2개월지2년,평균11개월,수부피판외관만의,7례피판균무수이차정형,수공능회복량호,대퇴공구창면유합호.안중화의학회수외과학회수공능평정표준평정:우4례,량2례,가1례.결론 천지혈관도항하초박고전외측피판수복창면시일충교이상적방법.
Objective To explore the clinical application of ultrathin anterolateral femoral perforator flap under the perforator vessel navigation to repair skin defects on hand.Methods Seven cases of hand skin defect were included.Skin defect area ranged from 5.5 cm × 7.2 cm to 10.0 cm × 12.5 cm.Perforator and piercing point position were determined by Doppler before operation to detect the anterolateral femoral perforator vessels.During operation,extra subcutaneous fat was removed,and anastomosis of the perforator vessels with the vessels of recipient sites was performed to reconstruct the flap blood circulation.The donor sites were sutured directly or repaired by skin grafting.Results All patients were follow-up for 2 to 24 months,11 months on average.Anterolateral femoral flaps of 7 cases all survived.Vascular crisis occurred in 1 case,in which thrombosis was found at anastomosis site.The flap was saved by removal of the thrombus.Flap margin necrosis occurred in 2 cases.Both wounds were saved by debridement and sutured directly.All flaps showed satisfactory appearance,no need for secondary procedures.Hand function recovered well,and the thigh donor sites healed well.According to the hand function evaluation standard,4 cases were excellent,2 good,and 1 acceptable.Conclusion The ultrathin anterolateral femoral perforator flap transfer under the perforator vessel navigation could be an ideal method to repair the hand skin defect.