论文部分内容阅读
目的:介绍一种穿支皮瓣血管切取的新方法——逆行四面解剖法,报道该方法在股前外侧穿支皮瓣（ALTPF）切取中的应用效果。方法:2013年6月至2016年12月,共收治四肢软组织缺损患者94例,应用逆行四面解剖法切取ALTPF（携带单一肌皮穿支）修复,术后观察皮瓣成活、受区外形、功能恢复和对供区外形与功能的影响情况。结果:切取皮瓣面积7 cm×5 cm~32 cm×10 cm,共解剖穿支94条,穿支来源于旋股外侧动脉降支89例,来源于旋股外侧动脉横支4例,来源于旋股内侧动脉1例。皮瓣切取时间35~95（54.39±16.39）min；术中出现穿支血管损伤1例,穿支切取成功率为98.9%,出现穿支血管痉挛1例；皮瓣供区直接闭合88例,植皮4例,局部皮瓣转移修复2例。术后皮瓣发生血管危象3例,其中静脉危象2例,动脉危象1例；除1例因静脉回流障碍出现部分坏死外,其它皮瓣均顺利成活。术后随访（12.91±9.17）个月,皮瓣供区肌力无减弱,膝关节活动正常。结论:在切取ALTPF时采用逆行四面解剖法处理穿支血管,操作相对传统方法较为简单、快速,并能减少供区损害,是一种可靠的处理穿支血管的方式。“,”Objective:To introduce a novel surgical technique for dissecting perforator vessels (orderly retrograde four-side dissection) in anterolateral thigh perforator flap (ALTPF) and explore its clinical outcome.Methods:Respective analysis of 94 patients who underwent reconstruction of soft tissue defects with ALTPF which were dissected by orderly retrograde four-side dissection between June, 2013 and December, 2016. After surgery, the survival of flaps, recovery in shape and function of the recipient sites, and the effect on shape and function of the donor sites were observed.Results:The size of ALTPF ranged from 7 cm×5 cm to 32 cm×10 cm. Ninety-four perforators were included in 94 ALTPF, which were 89 perforators of the descending branch of circumflex femoral lateral artery, 4 perforators of the transverse branch of circumflex femoral lateral artery and 1 perforator of femoral medial artery. The time for flap harvesting was 35-95(54.39±16.39) min. Success rate of perforator harvesting was 98.9%, only 1 perforator was injured and another encountered vasospasm during surgery. Three cases had vascular crisis after flap transfer with 2 venous crises and 1 artery crisis. All of the flaps completely survived except 1 that had a partial necrosis. The follow-up time was (12.91±9.17) months. No muscular weakness on donor sites was shown in all cases.Conclusion:Orderly retrograde four-side dissection of perforator vessels in the ALTPF has achieved less donor site morbidity, shorter surgical time and is safer than the traditional techniques. It is a reliable technique to harvest perforator flaps.