旋股外侧动脉降支穿支皮瓣显微削薄的临床应用
聂开瑜, 常树森, 魏在荣, 金文虎, 王波, 孙广峰, 唐修俊, 曾雪琴, 何春念
中国临床解剖学杂志 ›› 2017, Vol. 35 ›› Issue (1) : 90-93.
旋股外侧动脉降支穿支皮瓣显微削薄的临床应用
Clinical application of micro-debulking perforator flap based on descending branch of the lateral circumflex femoral artery
目的 探讨旋股外侧动脉降支穿支皮瓣显微削薄的临床应用效果。 方法 自2014年5月至2016年1月，笔者单位收治26例手足部皮肤软组织缺损患者。采用旋股外侧动脉降支穿支皮瓣修复创面，创面面积（外伤患者为扩创后面积）为6 cm×4 cm～15 cm×10 cm，切取皮瓣面积为8 cm×5 cm～21 cm×8 cm。皮瓣断蒂前在放大镜下根据II级穿支走行，保留II级穿支及其周围1 cm左右深筋膜组织，切除深筋膜及部分浅筋膜的脂肪组织，保留2～3 mm的真皮下脂肪，观察皮瓣血供良好后断蒂移植受区。 结果 25例皮瓣完全成活。1例皮瓣远端出现约2 cm×1 cm大小坏死，经换药2周愈合。皮瓣中央呈锥状臃肿，15例II期行中央臃肿修薄术。均获6～20个月随访，皮瓣外观满意，质地薄而柔软,感觉麻木。供区残留线状瘢痕。 结论 旋股外侧动脉降支穿支皮瓣可I期去除大部分深筋膜及部分浅筋膜组织、必要时II期去除皮瓣中央臃肿组织，减少II期皮瓣整形次数及手术难度。
Objective To investigate the effect of clinical application of the micro-debulking perforator flap based on the descending branch of the the lateral circumflex femoral artery. Methods Between May 2014 and January 2016, 26 cases of tissue defects of the hands and feet were repaired with the micro-debulking perforator flaps based on the descending branch of the lateral circumflex femoral artery. The soft tissue defect area ranged from 6 cm×4 cm to 15 cm×10 cm. The flaps ranged from 8 cm×5 cm to 21 cm×8 cm. According to the second-perforator course，the perforator and the deep fascia about 1 mm around it were preserved under a magnifying glass before cutting off the pedicle. The peripheral fat tissue was removed to the utmost extent. 2~3 mm thick circumferential fat tissues of the flaps were preserved. The flaps were transplanted to recipient site after excellent blood perfusion of the flaps was checked.15 cases are swelled obviously postoperatively, which was managed by re-open one edge of the flaps to remove the fatty tissue. Results Twenty-five flaps survived completely. Only one flap suffered partial margin necrosis with a size of 2 cm ×1cm, which was healed after dressing change for two weeks. Fifteen cases with centrally-located bulk was thinned in a second phase. Patients were followed up for 6 to 20 months. The appearance of flaps was satisfactory and the texture was thin and soft, and the sensation was numb.only linear scars could be seen in the donor site. Conclusions The perforator flap based on the descending branch of lateral circumflex femoral artery can withstand the removal of most of the deep fascia and superficial fascia tissue. If necessary, the central fat tissue of the flaps was removed in asecond phase, reducing the number of plastic surgery and the difficulty of operation.
外科皮瓣 / 旋股外侧动脉 / 修薄 / 软组织缺损 / 修复重建手术
Surgical flaps / Lateral circumflex femoral artery / Thinning / Soft tissue defect / Reparative and reconstructive surgery
[1] 徐达传, 钟世镇, 刘牧之, 等. 股前外侧部皮瓣的解剖学：一个新的游离皮瓣供区[J]. 临床应用解剖学杂志, 1984, 2(3):158-160.
[2] Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery[J]. Br J Plast Surg, 1984, 37(2): 149-159.
[3] Camporro D, García E, Barrio L. Versatility of the lateral circumflex femoral arterial (LCFA) system flaps for lower extremity soft tissue reconstruction[J]. Eur J Plast Surg , 2013, 36(9):559-566.
[4] 唐举玉, 吴攀峰, 俞芳， 等. 特殊类型穿支皮瓣在创伤骨科的临床应用[J]. 中华创伤杂志, 2014, 30(11):1085-1088.
[5] 黄雄杰, 唐举玉, 谢松林，等. 游离股前外侧超薄穿支皮瓣修复(MU)甲皮瓣供区创面[J]. 中华显微外科杂志, 2014, 37(3):271-273.
[6] Xie S, Deng X, Chen Y, et al. Reconstruction of foot and ankle defects with a superthin innervated anterolateral thigh perforator flap[J]. J Plast Surg Hand Surg, 2016, 50(6):367-374.
[7] Agostini T, Lazzeri D, Spinelli G. Anterolateral thigh flap thinning: techniques and complications[J]. Ann Plast Surg, 2014,72(2):246-252.
[8] Kimura N, Satoh K. Consideration of a thin flap as an entity and clinical applications of the thin anterolateral thigh flap[J]. Plast Reconstr Surg, 1996, 97(5): 985-992.
[9] Kimura N. A microdissected thin tensor fasciae latae perforator flap[J]. Plast Reconstr Surg, 2002,109(1):69-77.
[10] 唐举玉, 周征兵, 吴攀峰，等. 显微削薄穿支皮瓣技术在臃肿皮瓣二期削薄中的应用[J].中华显微外科杂志,2016,39(1):4-7.
[11] Gong ZJ, Wang K, Tan HY, et al. Application of Thinned Anterolateral Thigh Flap for the Reconstruction of Head and Neck Defects[J]. J Oral Maxillofac Surg, 2015, 73(7):1410-1419.
[12] 庄加川, 李敏姣, 陈乐锋，等. 穿支血管导航下超薄股前外侧皮瓣临床应用[J]. 中华手外科杂志, 2015, 31(2):113-115.
[13] 肖添有, 司徒朴, 陈伯华, 等. 轴型血管蒂股前外侧真皮下血管网皮瓣的应用解剖[J]. 中国临床解剖学杂志, 1997,15(1):7-9.
[14] 魏在荣. 皮瓣命名方式探讨[J/CD]. 中华损伤与修复杂志(电子版), 2011, 6(3): 337-341.
[15] 魏在荣. 皮瓣血供模式分类方式初步报告[J]. 遵义医学院学报, 2012, 35(4): 344-346.
[16] 魏在荣. 影响皮瓣成活的血管因素分析[J]. 中国美容整形外科杂志,2014, 25(3):129-131.
[17] Wei ZR, Sun GF, Wang DL, et al. Reconstruction of the Achilles tendon and overlying skin defect: 3 case reports[J]. Ann Plast Surg,2014 ,73(3): 325-329.
[18] 程红林, 孙晋中, 马林, 等. 手足臃肿皮瓣修整方法探讨[J]. 中华显微外科杂志, 2009,32(2):170.
[19] Huang SH, Wu SH, Chang KP, et a1. Contour refinements of free flaps for optimal outcome in oral reconstruction: combination of modified liposuction technique and w-plasty in one-stage procedure[J].Craniomaxillofac Surg, 2009, 37(4):201-205.
[20] Calderón W, Borel C, Roco H, et al. Primary closure of donor site in anterolateral cutaneous thigh free flap [J]. Plast Reconstr Surg, 2006, 117(7):2528-2529.
[21] Hanasono MM, Skoracki RJ, Yu P, et al. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients[J]. Plast Reconstr Surg, 2010, 125(1): 209-214.
[22] 唐修俊, 魏在荣, 王波, 等. 游离旋股外侧动脉穿支KISS皮瓣修复四肢创面的临床应用[J]. 中华显微外科杂志, 2015, 38(1):29-32.
[23] 金文虎, 魏在荣, 邓呈亮, 等. 游离旋股外侧动脉降支穿支组织瓣的临床应用及对供区影响观察[J].中国修复重建外科杂志, 2015, 29(10):1284-1287.
国家临床重点专科建设项目（2013-544）；贵州省优秀青年科技人才培养对象专项基金（2013-12）
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