目的 报道应用股前外侧穿支皮瓣修复糖尿病足溃疡临床效果。 方法 回顾性总结分析2020年3月-2024年3月收治的35例采用游离股前外侧穿支皮瓣修复糖尿病足溃疡患者的病例资料,平均年龄62岁（45~70岁），创面大小5.0 cm×6.5 cm~24.0 cm×8.0 cm，创面位置：前足11例、足背9例、足底9例、足跟6例，所有患者均一期清创+VSD负压引流控制感染，二期采用股前外侧穿支皮瓣游离移植修复创面。 结果 所有患者受区血管均有不同程度的动脉硬化，3例皮瓣发生动脉危象，1例抢救成功，2例皮瓣完全坏死而截肢；1例皮瓣静脉危象及皮瓣下积液，部分坏死，换药治疗后创面愈合，其余31例皮瓣完全存活，存活率91.4%（32/35），保肢率94.3%（33/35）；术后6个月，患者均能独自行走，足踝功能AOFAS评分73~95分，中位平均数87分；随访6~18个月，未见复发。 结论 股前外侧穿支皮瓣移植用于修复糖尿病足溃疡，可降低复发率和截肢率，并获得较好的功能及外观。
Abstract
Objectives To investigate the clinical application effect of the anterolateral thigh perforator flap for diabetic foot ulcer reconstruction. Methods A retrospective analysis was performed for the medical records of 35 patients from March 2020 to March 2024 who were treated with free anterolateral thigh perforator flap for diabetic foot ulcer reconstruction, the average age of the patients was 62 years old (45 to70 years), wound size was 5.0cm×6.5cm~24.0 cm×8.0cm. Wound location: 11 cases of forefoot, 9 cases of dorsum of feet, 9 cases of soles of feet, and 6 cases of heels. In all patients, infection was controlled by first-stage debridement and VSD negative pressure drainage. The wound was repaired by free transplantation of anterolateral thigh perforator flap in the second stage. Results All patients had varying degrees of arteriosclerosis in the donor site, 3 cases had arterial occluded with flap, 1 case was salvaged, and 2 cases had failed and amputation. One case had venous crisis, effusion under the flap, partial necrosis, wound healing after dressing change, and the rest of the flaps survived completely, with a survival rate of 91.4% (32/35) and the limb salvage rate of 94.3% (33/35). Six months after operation, all patients were able to walk independently, and the AOFAS score of foot and ankle function was 73-95 points, with a median average of 87 points. After 6-18 months follow-up, no recurrence was observed. Conclusions The anterolateral thigh perforator flap is used to repair diabetic foot ulcers, which can reduce the recurrence and amputation rates, and obtain satisfactory function and appearance.
关键词
股前外侧穿支皮瓣 /
糖尿病足 /
溃疡 /
负压式封闭引流 /
创面修复
Key words
Anterolateral thigh perforator flap /
Diabetic foot /
Ulceration /
Vacuum sealing drainage /
Wound repair
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基金
喀什地区科技局2021年科技计划项目(KS2021079)
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