CAJ | 학술논문

目的探讨采用双重供血的改良逆行股前外侧皮瓣修复复杂小腿毁损伤创面的临床疗效. 方法选择2011年7月-2014年3月采用双重供血的改良逆行股前外侧皮瓣修复小腿毁损伤创面患者6例,其中男4例,女2例;年龄25 ～56岁.致伤原因:交通伤4例,机器碾压伤2例.修复范围为8 cm× 10 cm～10 cm ×26 cm.应用高位皮支供血区切取带蒂逆行股前外侧皮瓣覆盖创面,根据“外增压”原理,180°旋转皮瓣后,通过旋股外侧动脉起始端与小腿动静脉吻合“双重”供血方式,增加皮瓣供血. 结果 6例皮瓣全部成活,其中2例出现术后皮瓣肿胀明显,肿胀影响静脉回流,给予皮瓣一侧边缘及蒂部拆线等处理后好转.3例皮瓣修复术后伤口甲级愈合.2例待皮瓣肿胀减退后再次缝合伤口,伤口甲级愈合.1例皮瓣术后感染,经过清创、换药等处理后痊愈.随访6 ～22个月,1例皮瓣术后2个月不慎被烫伤,经换药后痊愈.6例未发生后期感染,无骨髓炎及骨不连并发症发生. 结论双重供血的逆行股前外侧皮瓣外观满意、质地好、血管蒂长、切取面积大、存活率高、血运好、抗感染能力强,是修复小腿毁损伤创面的良好选择.
목적 탐토채용쌍중공혈적개량역행고전외측피판수복복잡소퇴훼손상창면적림상료효. 방법 선택2011년7월-2014년3월채용쌍중공혈적개량역행고전외측피판수복소퇴훼손상창면환자6례,기중남4례,녀2례;년령25 ～56세.치상원인:교통상4례,궤기년압상2례.수복범위위8 cm× 10 cm～10 cm ×26 cm.응용고위피지공혈구절취대체역행고전외측피판복개창면,근거“외증압”원리,180°선전피판후,통과선고외측동맥기시단여소퇴동정맥문합“쌍중”공혈방식,증가피판공혈. 결과 6례피판전부성활,기중2례출현술후피판종창명현,종창영향정맥회류,급여피판일측변연급체부탁선등처리후호전.3례피판수복술후상구갑급유합.2례대피판종창감퇴후재차봉합상구,상구갑급유합.1례피판술후감염,경과청창、환약등처리후전유.수방6 ～22개월,1례피판술후2개월불신피탕상,경환약후전유.6례미발생후기감염,무골수염급골불련병발증발생. 결론 쌍중공혈적역행고전외측피판외관만의、질지호、혈관체장、절취면적대、존활솔고、혈운호、항감염능력강,시수복소퇴훼손상창면적량호선택.
Objective To evaluate the clinical efficacy of retrograde femoral anterolateral skin flap with a dual blood supply for repairing complex destruction wound in calf.Methods From July 2011 to March 2014,6 patients with destructive wound in calf were treated by modified retrograde femoral anterolateral flaps with a dual blood supply.The patients aged 25-56 years consisted of 4 males and 2 females.There were 4 patients with traffic injury and 2 machine crush injury.Wound ranged from 8 cm× 10 cm to 10 cm × 26 cm.Pedicle retrograde femoral anterolateral flap supplied by high cutaneous branches was harvested to cover the wound.Based on the principle of " booster",flap blood flow was increased by anastomosis between lateral femoral circumflex artery and calf arteriovenous after 180 ° rotation of the skin flap.Results Flaps all survived.Markedly swollen flap was seen in 2 patients postoperatively,which impeded venous return,but significantly improved after stitches removal on one side of the flap.One-stage healing occurred in 3 patients.Good wound healing was noted in 2 patients while swelling subsided and secondary suture was done.Postoperative infection occurred in 1 patient and after debridement and dressing,the wound was finally healed.Two patients had scalded skin flap due to the careless two months after operation and healed after dressing.Follow-up lasted for 6 to 22 months with no delayed recurrent infection,myelitis and bone nonunion.Conclusion Retrograde femoral anterolateral flap with a dual blood supply may be a good option for wound repair of severe calf injury because of its normal appearance,good texture,long vascular pedicle,large surface area,high survival rate,improved flap blood supply and strong resistance to infection.