股前外侧皮瓣修复软组织缺损临床应用.docVIP

股前外侧皮瓣修复软组织缺损临床应用【摘 要】 目的 总结股前外侧皮瓣皮血管走行的解剖学特点和规律，并指导临床手术，提高手术成功率。方法 对38例股前外侧皮瓣移植手术中，对皮血管在旋股外侧动脉降支、?支及两支混合起源，对变异型血管蒂手术中灵活更改应用股外侧皮瓣。结果 38例股前外侧皮瓣，除1例部分坏死外，其余全部移植成功。结论 旋股外侧动脉不论分支如何，供应股前外侧皮瓣皮支恒定，即使手术中皮瓣移植遇到降支无粗大皮支时，不要轻易放弃，改用高位皮血管，仍可使皮瓣移植成功。 ?【关键词】 股前外侧皮瓣；皮血管；缺损 The clinical application on soft tissue defect of anterolateral femoral skin flapWANG Zhan-you，CHE Yi,HU Zhong-mou．Department of Orthopedics,Shandong Province，Weihaiwei People′s Hospital，Weihai 264200， China?【Abstract】 Objective To investigate the anatomic characteristic of the cutaneous blood vessel of anterolateral femoral flap,to direct clinical operation．Methods The orgins of cutaneous blood vessels from lateral femoral circumflex arteries，they passed through muscles or not，the lengths and depths when they were under the muscles and the position where they derived from the muscles were observed in 38 cases of anterolateral femoral flap transplantation．Results 38 case was no necrosis of tissue and all wound healed well，One case was necrosis the part of anterolateral skin flap．Conclusion thiugh the type of the cutaneous blood vessels of anterolateral femoral flap is different,in most individuals the descending branch of lateral femoral circumflex artery as a main branch exits and sends out a dominant branch constantly．If the large cutaneous branch can not be found during transplantation,we can use cutaneous blood vessel with higher position instead of giving up the operation． 【Key words】 Anterolateral femoral skin flap;Surgery flap blood supply；Defect 以旋股外侧血管降支为蒂的股前外侧皮瓣自1984年徐达传、罗力生等首先报道该皮瓣的解剖学和临床应用以来[1-2]，已在临床广泛应用，现已成为修复较大软组织缺损时的首选常用最佳供区之一。总结我院1998年6月至2007年6月应用游离股前外侧皮瓣转移修复小腿及足踝部皮肤大的软组织缺损38例，根据临床皮瓣血管解剖特点，特别是一些变异血管的皮支走行的更改手术，总结了一定的临床经验教训，现报告如下。 1 材料与方法 1．1 一般资料 患者38例，男32例，女6例，年龄18～54岁。左侧20例，右侧18例，小腿18例，足踝20例，致伤原因：车祸28例，砸伤6例，撕脱伤4例，急诊修复10例，二期在3～35 d修复28例。以上软组织缺损均较大，均伴随胫腓骨骨折及足踝关节骨折及脱位，部分神经感觉支损伤，肌肉断裂部分缺损等。 1．2 治疗方法 根据实际情况灵活运用内固定，此种外伤原则上以外固定为佳。该组18例小腿骨折病例10例骨折采用单侧外固定架固定，8例采取钢板内固定，足踝部固定采取钢针及螺钉内固定，皮