CAJ | 학술논문

目的探讨股前外侧皮瓣游离移植修复下肢及足部软组织缺损的临床疗效. 方法选取2014年4月至2015年5月间,使用股前外侧皮瓣游离移植治疗下肢及足踝部软组织缺损的8例患者. 术前通过B超及CT血管造影( computed tomography angiography, CTA)定位穿支血管的位置,术中对比血管定位位置后进行血管蒂分离. 皮瓣切取面积为15 cm×15 cm~25 cm×15 cm. 本组患者由于受区感觉神经缺损,均未进行受区感觉神经的修复. 术后随访3个月以上,观察患者皮瓣外观及功能. 结果 8例患者中,7例患者皮瓣术后存活,皮瓣对患处覆盖良好并有较好的外观及功能. 1 例患者术后第2天出现动脉危象,行探查术后再次出现静脉危象导致皮瓣部分坏死,清除坏死皮瓣组织,进行植皮换药后伤口愈合良好. 结论股前外侧皮瓣游离移植是游离皮瓣修复下肢及足踝部皮肤缺损中的经典术式,不仅可以减少患者的供区损伤,受区也可以得到良好的功能修复,但是在治疗过程中必须注意神经功能恢复及患肢的骨性功能恢复.
목적 탐토고전외측피판유리이식수복하지급족부연조직결손적림상료효. 방법 선취2014년4월지2015년5월간,사용고전외측피판유리이식치료하지급족과부연조직결손적8례환자. 술전통과B초급CT혈관조영( computed tomography angiography, CTA)정위천지혈관적위치,술중대비혈관정위위치후진행혈관체분리. 피판절취면적위15 cm×15 cm~25 cm×15 cm. 본조환자유우수구감각신경결손,균미진행수구감각신경적수복. 술후수방3개월이상,관찰환자피판외관급공능. 결과 8례환자중,7례환자피판술후존활,피판대환처복개량호병유교호적외관급공능. 1 례환자술후제2천출현동맥위상,행탐사술후재차출현정맥위상도치피판부분배사,청제배사피판조직,진행식피환약후상구유합량호. 결론 고전외측피판유리이식시유리피판수복하지급족과부피부결손중적경전술식,불부가이감소환자적공구손상,수구야가이득도량호적공능수복,단시재치료과정중필수주의신경공능회복급환지적골성공능회복.
Objective To investigate the curative effect of anterolateral thigh ( ALT) free flap in the treatment of lower limb and foot soft tissue defects. Methods A total of eight patients with lower limb and/ or foot soft tissue defects enrolled from Apr. 2014 to May 2015 were collected in this study. Preoperative ultra-sound and computer tomography were performed to locate the perforator artery, and the exact location of the per-forator arteries were compared to the preoperative ones. The flaps ranged from 15 cm×15 cm to 25 cm×15 cm. Due to sensory nerve defects in the affected area, the sensory nerves in the affected area were not repaired. During the 3 months follow-up, the appearance of the flap and the functions of the lower limb and foot were ob-served. Results After surgeries, seven out of eight flaps survived, the flap coverage was acceptable with ap-propriate appearance and function. One patient had an arterial crisis 48 hours after the operation. An explorato-ry-operation was performed and venous crisis occurred after the operation resulting in partial flap necrosis. Re-moval of the necrotic tissue and skin grafting were then performed to cover the wound area. Conclusion Free ALT flap transportation is the classical and appropriate surgical procedure for repairing soft tissue defect of the lower limb and foot. ALT flap can not only reduce donor site secondary injury, but also allows the recipient site to regain its required function. However, more attention should be paid on the recovery of the sensory nerves and fracture bones of the affected area.