游离股前外侧穿支皮瓣修复足前端缺损.docVIP

游离股前外侧穿支皮瓣修复足前端缺损 　　[摘要]目的：探讨应用股前外侧穿支皮瓣修复足远端缺损的效果。方法：切取股前外侧穿支皮瓣，皮瓣切取面积为8cm×16cm～15cm×18cm。供区直接缝合或断层皮片移植修复，与足背动静脉吻合，修复足前端缺损15例。结果：15例患者皮瓣均完全成活，其中4例出现静脉危象，经探查修复后缓解，患者恢复行走功能，避免了截肢。结论：股前外侧穿支皮瓣股前外侧皮瓣供区隐蔽，简便实用,是修复足远端缺损的理想选择。 　　[关键词]游离皮瓣；缺损；足 　　[中图分类号]R622[文献标识码]A[文章编号]1008-6455（2014）09-0701-03 　　 　　The clinical application of the anterolateral thigh skin flap to repair the defects in the distal part of foot 　　WU Lei,ZHANG Jun-feng,MA Fu-lian 　　(Department of Plastic Surgery,Zhengzhou First Peoples Hospital,Zhengzhou 450000,Henan,China) 　　 　　Abstract:Objective To study the effect of free anterolateral thigh flap (ALT)in the reconstruction of skin and soft tissue defect in the distal part of foot. Methods 15 patients of skin and soft tissue defects in the distal part of foot were repaired with free anterolateralthigh flaps.The sizes of flaps were from 8 cm × 16 cm to 15cm × 18cm. Donors were sutured or repaired with transplantation of free skin graft. Blood vessels of flaps were connected with dorsal artery and vein of feet. Results All the flaps survived completely.Vascular crisis occurred in four flap after operation and restored blood circulation through emergency operation. All the patients recovered the function of walking.ConclusionsThe anterolateral thigh flap is simple and practical and the donor is hidden. The flap is suitable for repair the defects in the distal part of foot. 　　Key words:free flap;defect;foot 　　足前端缺损多见于碾轧伤和内科疾病导致远端血液循环障碍引起的组织坏死，如糖尿病及脉管炎等，近年来此类疾病的发生率逐渐增多。由于足远端为足趾，清创后遗留的创面并伴有骨断端的外露。由于足远端位置特殊，且缺损面积往往较大，传统的局部皮瓣因为可覆盖的创面面积小或位置较远难以修复，以往经验通常行经“跗跖关节”的半足离断手术甚至是踝关节的高位离断手术以封闭创面。手术虽简单易行，但创伤大，导致伤残发生，患者需扶拐或安装假肢行走，生活质量下降。为了解决这一问题，减低伤残率，笔者努力探寻一种合适方法来修复此类创面。股前外侧皮瓣临床应用非常广泛，被称为“万能皮瓣”[1]，我科自2010年以来采用游离股前外侧穿支皮瓣（ALTPF）修复足远端缺损15例，保全了患者的肢体，取得了满意的效果，现报道如下。 　　 　　1资料和方法 　　1.1 一般资料：本组共15例，男性11例，女性4例；年龄17～65岁，平均42岁。其中碾轧伤12例，内科疾病导致足远端组织坏死3例，1期完成皮瓣修复6例，其余经清创或负压吸引后2期修复。皮瓣切取面积为8.0cm×16.0cm～15.0cm×18.0cm。 　　1.2 手术方法 　　1.2.1 受区准备：创面进行彻底清创至正常组织，以创缘有丰富的渗血为指标。解剖出足背动