CAJ | 학술논문

目的探讨股前外侧组织瓣不规则切取移植修复下肢多处皮肤软组织缺损创面的疗效. 方法 2009年1月至2014年1月,采用股前外侧组织瓣不规则切取移植修复下肢多处皮肤软组织缺损创面病例共7例.创面缺损部位:小腿内侧加小腿外侧2例,足背加踝关节3例,内踝加外踝2例;所有病例均在骨折同定、创面无明显感染下进行;游离组织瓣血管蒂均用旋股外侧动脉降支,其切取股前外侧不规则组织瓣类型:股前外侧穿支皮瓣加旋股外侧动脉终末支肌瓣3例,股前外侧穿支皮瓣加旋股外侧动脉横支肌瓣2例,重构分叶型股前外侧穿支皮瓣2例(分叶股前外侧穿支皮瓣蒂部血管与旋股外侧动脉主干分支吻合);不规则切取单叶组织瓣面积6cm ×4cm～ 16cm×12 cm;组织瓣供区均一期直接缝合关闭.所有病例均于术后4周在支具保护下行早期康复训练. 结果术后随访6～14个月,平均8.2个月;皮瓣全部成活,仅2例皮瓣边缘小面积坏死,经换药、清创、植皮等治疗后完全愈合;创面愈合时间12 ～ 34 1,平均17.1d;术后皮瓣面积无明显同缩,色泽与受区相似,供区瘢痕挛缩不明显. 结论切取由同一源血管供养的股前外侧组织瓣移植修复下肢多处皮肤软组织缺损创面,是安全有效的策略;各组织瓣可经过不同的设计与组合,一次性修复多个不规则创面,其供区损伤小,缩短治疗周期,减轻患者痛苦.
목적 탐토고전외측조직판불규칙절취이식수복하지다처피부연조직결손창면적료효. 방법 2009년1월지2014년1월,채용고전외측조직판불규칙절취이식수복하지다처피부연조직결손창면병례공7례.창면결손부위:소퇴내측가소퇴외측2례,족배가과관절3례,내과가외과2례;소유병례균재골절동정、창면무명현감염하진행;유리조직판혈관체균용선고외측동맥강지,기절취고전외측불규칙조직판류형:고전외측천지피판가선고외측동맥종말지기판3례,고전외측천지피판가선고외측동맥횡지기판2례,중구분협형고전외측천지피판2례(분협고전외측천지피판체부혈관여선고외측동맥주간분지문합);불규칙절취단협조직판면적6cm ×4cm～ 16cm×12 cm;조직판공구균일기직접봉합관폐.소유병례균우술후4주재지구보호하행조기강복훈련. 결과 술후수방6～14개월,평균8.2개월;피판전부성활,부2례피판변연소면적배사,경환약、청창、식피등치료후완전유합;창면유합시간12 ～ 34 1,평균17.1d;술후피판면적무명현동축,색택여수구상사,공구반흔련축불명현. 결론 절취유동일원혈관공양적고전외측조직판이식수복하지다처피부연조직결손창면,시안전유효적책략;각조직판가경과불동적설계여조합,일차성수복다개불규칙창면,기공구손상소,축단치료주기,감경환자통고.
Objective To investigate the clinical effect of harvesting the free anterolateral thigh flap irregularly for the repair of the multiple and complex skin and soft tissue defect at lower limb.Methods From January,2009 to January, 2014, 7 patients with multiple and complex skin and soft tissue defect at lower limb were treated with transplantation of the free anterolateral thigh flap with harvesting irregularly.The parts of wound defect: 2 cases of medial leg andlateral leg, 3 cases of foot back andankle, and 2 cases of medial malleolus and lateral malleolus.All the cases were operated in fracture fixation and wound without obvious infection.The vascular pedicle of free flaps were descending branch of lateral circumflex femoral artery.The types of the harvesting the free anterolateral thigh flap irregularly: 3 cases of the anterolateral thigh flap and terminal branch of lateral femoral circumflex artery muscle flap, 2 cases of the anterolateral thigh flap and transverse branch of lateral circumflex femoral artery muscle flap, and 2 cases of reconstructed lobar femoral anterolateral thigh perforator flap (vascular anastomosis of pedicle of lobulated anterolateral thigh perforator flap with the main stem branch artery of the lateral femoral circumflex vessels).The area of harvesting the free anterolateral thigh flap irregularly were 6 cm × 4 cm to 16 cm × 12 cm;The donor site were closed directly.All the patientsbegined to early rehabilitative exercise under the protection of orthosis after 4 weeks of the operation.Results All cases were followed up for 6 to 14 months, and the average of 8.2 months.All the flaps survived, besides 2 cases with necrosis of small area in distal, and which were healed by dressing, debridement,skin grafting and so on;The healing time were 12 to 34 days, and the average of 17.1 days.The area of flaps without obvious retraction, color were the same as the region, no obvious scar contracture.Conclusion The anterolateral thigh flap feed by the same source vessels for the repair of the multiple and complex skin and soft tissue defect at lower limb is a safe and effective strategy.The flap can be combinated differently to repair multiple and irregular wound one-time, the donor site is small invasive, shorten the treatment cycle, and relieve the suffering.