目的 探讨端侧吻合非一级源血管的游离股前外侧穿支皮瓣（ALTPF）修复四肢软组织缺损的临床疗效。 方法 2020年2月至2021年7月，皖南医学院第一附属医院手足外科收治14例四肢软组织缺损患者，其中男12例，女2例，年龄30~69岁，平均52岁。创面位于左手1例，左足及踝关节7例，右足及踝关节6例。创面大小7 cm×7 cm~9 cm×22 cm，均伴有肌腱、神经或骨组织外露。采用端侧吻合非一级源血管的游离ALTPF修复创面，皮瓣切取面积8 cm×8 cm~10 cm×23 cm，术中将非一级源血管的皮瓣动脉与受区动脉端侧吻合，皮瓣静脉与受区动脉的伴行静脉端端吻合，供区均直接缝合。术后进行门诊或微信随访，观察皮瓣及供区愈合情况，使用Likert量表评价患者对重建外观的满意度。 结果 术后本组皮瓣均完全成活，1例受区创面术后反复渗出，经换药引流后愈合；供区手术切口均一期愈合。患者均获随访，随访时间9~18个月，平均12。6个月，皮瓣质软，外形良好，无明显臃肿。末次随访时，根据Likert量表评价重建肢体外观，获优4例，良8例，可2例。 结论 端侧吻合非一级源血管的游离ALTPF可有效修复四肢软组织缺损，皮瓣血运可靠，能获得良好的重建外观。 Objective To explore the clinical effects of end-to-side anastomosis of non-primary perforating vessels carried by free anterolateral thigh perforator flap (ALTPF) in reconstruction of soft tissue of limb。 Methods Between February 2020 and July 2021， 14 patients with soft tissue defect of limb were admitted in the Department of Hand and Foot Surgery， the First Affiliated Hospital of Wannan Medical College。 The patients were 12 males and 2 females， aged between 30 and 69 years old， with a median age of 52 years old。 One defect was found in left hand， 7 in left foot and ankle and 6 in right foot and ankle。 Wound sizes were 7 cm×7 cm-9 cm×22 cm， all accompanied with exposed tendons， nerves or bone tissue。 The size of flaps ranged from 8 cm×8 cm to 10 cm×23 cm。 ALTPFs carrying non-primary source vessels were applied in reconstruction of soft tissue defects。 The non-primary perforating vessels of ALTPF was anastomosed with the artery in recipient site in an end-to-side fashion and the vein of ALTPF was end-to-end anastomosed with the accompanying vein of the recipient artery。 All donor sites were sutured directly。 The follow-up was conducted by online reviews via WeChat or by visit of outpatient clinics。 Appearance of flap and donor site were observed and the aesthetic satisfaction of the patients recipient sites were assessed subjectively using Likert scale。 Results All 14 ALTPFs survived uneventfully。 Wound exudation occurred in 1 flap， and healed after dressing change and drainage。 All patients received 9-18 (mean 12。6) months of follow-up。 The ALTPFs were in good texture and shape。 According to the Likert scale， appearance were excellent in 4 flaps， good in 8 flaps and fair in 2 flaps。 Conclusion Application of free ALTPF of non-primary source vessels with end-to-side anastomosis is not only effective in the reconstruction of limb defects， but also has advantages of reliable blood perfusion and cosmetic appearance。
End-to-side anastomosis of non-primary perforating vessels of free anterolateral thigh perforator flap in reconstruction of soft tissue defect of limb: a report of 14 cases
Objective To explore the clinical effects of end-to-side anastomosis of non-primary perforating vessels carried by free anterolateral thigh perforator flap (ALTPF) in reconstruction of soft tissue of limb. Methods Between February 2020 and July 2021, 14 patients with soft tissue defect of limb were admitted in the Department of Hand and Foot Surgery, the First Affiliated Hospital of Wannan Medical College. The patients were 12 males and 2 females, aged between 30 and 69 years old, with a median age of 52 years old. One defect was found in left hand, 7 in left foot and ankle and 6 in right foot and ankle. Wound sizes were 7 cm×7 cm-9 cm×22 cm, all accompanied with exposed tendons, nerves or bone tissue. The size of flaps ranged from 8 cm×8 cm to 10 cm×23 cm. ALTPFs carrying non-primary source vessels were applied in reconstruction of soft tissue defects. The non-primary perforating vessels of ALTPF was anastomosed with the artery in recipient site in an end-to-side fashion and the vein of ALTPF was end-to-end anastomosed with the accompanying vein of the recipient artery. All donor sites were sutured directly. The follow-up was conducted by online reviews via WeChat or by visit of outpatient clinics. Appearance of flap and donor site were observed and the aesthetic satisfaction of the patients recipient sites were assessed subjectively using Likert scale. Results All 14 ALTPFs survived uneventfully. Wound exudation occurred in 1 flap, and healed after dressing change and drainage. All patients received 9-18 (mean 12.6) months of follow-up. The ALTPFs were in good texture and shape. According to the Likert scale, appearance were excellent in 4 flaps, good in 8 flaps and fair in 2 flaps. Conclusion Application of free ALTPF of non-primary source vessels with end-to-side anastomosis is not only effective in the reconstruction of limb defects, but also has advantages of reliable blood perfusion and cosmetic appearance.
万方数据
