游离阔筋膜瓣移植修复小腿软组织和主要血管缺损

摘要

目的:总结吻合血管的阔筋膜瓣移植修复小腿软组织和主要血管缺损的临床应用结果.方法:2000年9月至2008年12月,应用阔筋膜瓣移植修复5例(男4例,女1例)小腿软组织和主要血管缺损,用其携带的旋股外侧动脉降支行桥式吻合,同时修复受区肢体主要血管缺损.患者年龄19～48岁,平均34岁.切取阔筋膜瓣范围6.5 cm×9 cm～9 cm×18 cm,Ⅰ期行中厚网状游离植皮,股部供区直接缝合.结果:阔筋膜瓣全部成活,手术顺利.随访时间11个月～3.5年.平均2.5年.未发现明显的供区功能障碍,供区与受区外形较好,受区小腿经临床观察与Doppler检查,胫前和胫后动脉通畅.结论:阔筋膜瓣以旋股外侧动脉降支为血供,血运丰富、血管解剖恒定、血管蒂长以及切取容易,而且较薄,适宜修复小腿软组织和主要血管缺损.%Objective: To summarize the clinical applications of fascia lata free flaps transplantation to repair soft tissue and main vascular defects of the legs. Methods:From September 2000 to December 2008,5 patients (4 men, 1 women)with soft tissue and main vascular defects of the legs underwent reconstruction with the fascia lata free flaps by microvascular anastomoses. Vascular defect was repaired with descending branch of circumflex femoral lateral artery by end-to-end anastomosis. They ranged in age from 19 to 48 years (mean ,34 years). The fascial lata flaps ranged from 6.5 cm×9 cm～9 cm×18 cm.The intermediate split thickness skin graft was performed and the thigh donor site was closed directly. Results:All the fascia lata flaps had survived completely with satisfactory clinical results. Follow-up duration ranged from 11 months to 3.5 years (mean 2.5 years). There was no remarkable donor site morbidity. All cases had good appearances in recipient and donor site. The patency of the posterior tibial and anterior artery of the legs in recipient was demonstrated clinically and Doppler examination. Conclusion:The fascia lata flap is nourished by the descending branch of the lateral circumflex femoral artery.The flaps seem to have highly vascularization,a constant vascular anatomy and a long vascular pedicle, so that dissection of the flaps could become accomplished easily. The flap is thin and suitable for repairing of soft tissue and main vascular defects of the legs.