【摘要】 目的探析应用股前外侧皮瓣游离修复软组织缺损患者的术后并发症对供区功能的影响,以及供区肌力与感觉的影响因素。方法回顾性分析66例下肢软组织缺损行股前外侧皮瓣游离修复患者的临床资料,其中37例采用股前外侧皮瓣+直接缝合(A组),29例采用股前外侧皮瓣+植皮修复(B组);比较2组术后并发症的总发生率。根据改良Lovett分级标准,评估术后6个月时患者的供区肌力与感觉恢复因素,并对其性别、年龄、皮瓣大小、皮瓣类型、修复方式进行比较分析。结果 A、B组患者的植皮坏死发生率分别为0、17.24%(5/29),其差异有统计学意义(P<0.05);A、B组患者的并发症总发生率分别为18.92%(7/37)和34.48%(10/29),其差异无统计学意义(P>0.05)。术后6个月评估,对肌力良好组与肌力较差组患者在性别、年龄、皮瓣大小、皮瓣类型及修复方式方面进行比较,其差异无统计学意义(P>0.05);供区感觉良好组与感觉较差组患者在性别、年龄、皮瓣类型及修复方式方面进行比较,其差异无统计学意义(P>0.05)。在感觉良好组中,皮瓣面积≤60 cm2的占78.18%(43/55),高于感觉较差组(36.36%,4/11),其差异有统计学意义(P<0.05)。结论股前外侧皮瓣的血管走行相对桓定,变异较小,切取范围较大,是修复下肢软组织缺损的较理想供区;术前调整患者的身体状态,控制皮瓣大小,减少股外侧肌支损伤,并结合实际情况修复供区,有利于术后供区功能的恢复,且可减少术后并发症的发生。更多还原

【Abstract】 Objective To investigate the postoperative complications and the factors affecting function, muscle strength, and sensation of the donor area of the anterolateral thigh flap in the free repair of soft tissue defects. Methods Retrospective analysis of the clinical data of 66 patients with lower extremity soft tissue defects who underwent free repair of anterolateral thigh flap. Patients were divided into2 groups. In group A, 37 cases received treatment of anterolateral thigh flap and direct suture. In group B, 29 cases received treatment of anterolateral thigh flap and skin graft. The total incidence of postoperative complications was compared between groups A and B. According to the modified Lovett grading standard, the recovery factors of donor muscle strength and sensation were assessed. The gender, age, size of flap, type of flap, and the reparative method were compared and analyzed. Results The skin graft necrosis rate was 0 and 17.24%(5/29)in group A and B, respectively. The difference was statistically significant(P<0.05). The total incidence of postoperative complications was18.92%(7/37) and 34.48%(10/29) in group A and B, respectively. The difference was not statistically significant(P>0.05). Six months after the operation, the assessment results of gender, age, size of flap, type of flap, and the reparative method between the groups of good and poor muscle strength were not statistically significant(P>0.05). Between the good and poor sensation group, the above indexes were also not statistically significant(P>0.05). In the group with good sensation, the percentage of flap size ≤60 cm~2 was 78.18%(43/55), which was higher than that in the group with poor sensation of 36.36%(4/11). The difference was statistically significant(P<0.05). Conclusion The vascular direction of the anterolateral thigh flap was relatively stable, with small variation and large available range for flap incision. It was an ideal donor area for the repair of a lower extremity soft tissue defect. Improving the patient′s physical condition before surgery, controlling the size of the flap, reducing lateral femoral branch injury, and taking into account the condition of the patients before repairing the donor area assisted in the recovery of function, and reduced the incidence of postoperative complications.更多还原