股前外侧皮瓣游离移植联合负压封闭引流技术修复下肢远端软组织缺损(1)
[摘要]目的：探讨股前外侧皮瓣游离移植联合负压封闭引流技术(Vacuum sealing drainage， VSD)修复下肢远端软组织缺损的临床疗效。方法：将笔者医院收治的86例严重下肢皮肤或软组织缺损患者随机分为观察组和对照组，每组43例。观察组采用VSD联合股前外侧皮瓣游离移植修复，对照组采用股前外侧皮瓣游离移植联合常规引流，比较两组患者临床疗效及感染发生率等。结果：观察组治疗总有效率为93.02%，高于对照组的83.72%，差异有统计学意义(P<0.05)。观察组创面愈合时间、感染率明顯低于对照组，皮瓣移植愈合率高于对照组，差异均有统计学意义(P<0.05)。讨论：股前外侧皮瓣游离移植联合VSD修复下肢远端软组织缺损，疗效好，操作简便，是值得推广的临床治疗方案。
[关键词]股前外侧皮瓣；负压封闭引流技术；软组织缺损；移植
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)06-0025-03
, 百拇医药
Abstract： Objective To investigate effect of femoral anterior lateral flap free transplantation combined with vacuum sealing drainage in repairing of distal soft tissue defect of lower extremity. Methods Eighty-six patients with distal soft tissue defect of lower extremity in our hospital were randomly divided into the observation group and the control group， 43 cases in each group. The observation group was treated with femoral anterior lateral flap free transplantation combined with vacuum sealing drainage， while the control group received femoral anterior lateral flap free transplantation combined with common pressure drainage. The clinical efficacy and incidence of infection were compared between the two groups. Results The total effective rate of the observation group was 93.02%， which was higher than that in the control group(83.72%)， the difference was statistically significant(P<0.05). The wound healing time and infection rate in the observation group were significantly lower than those in the control group， and the healing rate of skin flap transplantation was higher than that of the control group(P<0.05). Conclusion Femoral anterior lateral flap free transplantation combined with VSD for repairing distal soft tissue defect of the lower limb is easy to operate and has high efficiency.It is a worthy clinical treatment plan.
, 百拇医药
Key words： anterolateral thigh flap； VSD； soft tissue injuries； transplant
由于机械外伤导致的下肢及足部皮肤和软组织缺损在临床上较为多见，严重时会造成骨质、肌腱外露[1]。在此情况下，不能再用简单的皮肤移植来进行处理。而应首先考虑采用皮瓣移植的治疗方式[2]。本文以笔者医院收治的较为严重的下肢皮肤及软组织缺损患者为研究对象，研究和探讨股前外侧皮瓣游离移植联合封闭式负压引流技术(Vacuum sealing drainage， VSD)的治疗效果，现报道如下。
1 资料和方法
1.1 一般资料：以笔者医院2014年6月-2016年6月收治的86例下肢皮肤及软组织缺损患者为研究对象，随机分为对照组和观察组，每组43例。对照组：男23例，女20例；年龄为26～62岁，平均(45.36±5.45)岁；病程5h～14d，平均(3.24±0.87)d；缺损部位：小腿外部13例，足背部9例，内踝部5例，外踝部9例，膝关节部5例，足底2例。观察组：男26例，女17例，年龄为25～60岁，平均(44.56±4.87)岁；病程4h～14d，平均(3.58±0.72)d；缺损部位：腿外部13例，足背部8例，内踝部7例，外踝部8例，膝关节部4例，跟腱部2例，足底1例。两组患者的性别、年龄及病程等基础资料比较，差异无统计学意义(P>0.05)。
, 百拇医药
1.2 治疗方法
1.2.1 对照组：采用股前外侧皮瓣游离移植联合常规引流进行治疗[3]。①术前对创面彻底清创和消毒处理：切除坏死组织和创面皮缘，用生理盐水或双氧水进行消毒；②在远离创面的部位放置止血带，监测和观察动脉射血情况，如果搏动无力可采取近侧解剖的方式；③皮瓣设计及制备：术前在髂前上棘至髌骨外缘连线，以连线中点为圆心，画半径5cm的圆形区域，定位主要穿支血管位置，根据患者受区面积大小，选取较受区大2cm的区域为皮瓣供区；④皮瓣制备：沿设计线切开皮肤、皮下脂肪及阔筋膜，将皮瓣向外翻出，锐性分离探查穿支位置。在近肌肉组织处，注意保护肌间穿支及肌皮穿支。沿穿支分离至旋股外侧动脉。根据受区血管情况切取皮瓣及血管蒂长度，皮瓣面积较大时应留有2～3支穿支血管；⑤皮瓣完全分离后，用肝素盐水反复冲洗[4]，修正皮瓣边缘，敷于皮瓣受区并重建血管，缝合皮瓣；⑥术后常规放置引流管，常规给药换药。, http://www.100md.com(张军 刘晓雪)
[关键词]股前外侧皮瓣；负压封闭引流技术；软组织缺损；移植
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)06-0025-03
, 百拇医药
Abstract： Objective To investigate effect of femoral anterior lateral flap free transplantation combined with vacuum sealing drainage in repairing of distal soft tissue defect of lower extremity. Methods Eighty-six patients with distal soft tissue defect of lower extremity in our hospital were randomly divided into the observation group and the control group， 43 cases in each group. The observation group was treated with femoral anterior lateral flap free transplantation combined with vacuum sealing drainage， while the control group received femoral anterior lateral flap free transplantation combined with common pressure drainage. The clinical efficacy and incidence of infection were compared between the two groups. Results The total effective rate of the observation group was 93.02%， which was higher than that in the control group(83.72%)， the difference was statistically significant(P<0.05). The wound healing time and infection rate in the observation group were significantly lower than those in the control group， and the healing rate of skin flap transplantation was higher than that of the control group(P<0.05). Conclusion Femoral anterior lateral flap free transplantation combined with VSD for repairing distal soft tissue defect of the lower limb is easy to operate and has high efficiency.It is a worthy clinical treatment plan.
, 百拇医药
Key words： anterolateral thigh flap； VSD； soft tissue injuries； transplant
由于机械外伤导致的下肢及足部皮肤和软组织缺损在临床上较为多见，严重时会造成骨质、肌腱外露[1]。在此情况下，不能再用简单的皮肤移植来进行处理。而应首先考虑采用皮瓣移植的治疗方式[2]。本文以笔者医院收治的较为严重的下肢皮肤及软组织缺损患者为研究对象，研究和探讨股前外侧皮瓣游离移植联合封闭式负压引流技术(Vacuum sealing drainage， VSD)的治疗效果，现报道如下。
1 资料和方法
1.1 一般资料：以笔者医院2014年6月-2016年6月收治的86例下肢皮肤及软组织缺损患者为研究对象，随机分为对照组和观察组，每组43例。对照组：男23例，女20例；年龄为26～62岁，平均(45.36±5.45)岁；病程5h～14d，平均(3.24±0.87)d；缺损部位：小腿外部13例，足背部9例，内踝部5例，外踝部9例，膝关节部5例，足底2例。观察组：男26例，女17例，年龄为25～60岁，平均(44.56±4.87)岁；病程4h～14d，平均(3.58±0.72)d；缺损部位：腿外部13例，足背部8例，内踝部7例，外踝部8例，膝关节部4例，跟腱部2例，足底1例。两组患者的性别、年龄及病程等基础资料比较，差异无统计学意义(P>0.05)。
, 百拇医药
1.2 治疗方法
1.2.1 对照组：采用股前外侧皮瓣游离移植联合常规引流进行治疗[3]。①术前对创面彻底清创和消毒处理：切除坏死组织和创面皮缘，用生理盐水或双氧水进行消毒；②在远离创面的部位放置止血带，监测和观察动脉射血情况，如果搏动无力可采取近侧解剖的方式；③皮瓣设计及制备：术前在髂前上棘至髌骨外缘连线，以连线中点为圆心，画半径5cm的圆形区域，定位主要穿支血管位置，根据患者受区面积大小，选取较受区大2cm的区域为皮瓣供区；④皮瓣制备：沿设计线切开皮肤、皮下脂肪及阔筋膜，将皮瓣向外翻出，锐性分离探查穿支位置。在近肌肉组织处，注意保护肌间穿支及肌皮穿支。沿穿支分离至旋股外侧动脉。根据受区血管情况切取皮瓣及血管蒂长度，皮瓣面积较大时应留有2～3支穿支血管；⑤皮瓣完全分离后，用肝素盐水反复冲洗[4]，修正皮瓣边缘，敷于皮瓣受区并重建血管，缝合皮瓣；⑥术后常规放置引流管，常规给药换药。, http://www.100md.com(张军 刘晓雪)