游离股深动脉穿支皮瓣修复手及前臂软组织缺损

Repair of hand and forearm soft tissue defects with free deep femoral artery perforator flap

摘要:

［目的］ 通过与股前外侧皮瓣比较，评价游离股深动脉穿支皮瓣修复手和前臂创伤性皮肤缺损的临床效果。［方法］ 回顾性分析 2015 年 2 月—2019 年 8 月本院手术治疗手和前臂创伤性皮肤缺损 106 例患者的临床资料。其中，56 例接受游离股深动脉穿支皮瓣修复治疗 （股深动脉组），50 例接受股前外侧皮瓣修复治疗 （股外侧组）。比较两组围手术期与随访资料。［结果］两组患者均顺利完成手术。股深动脉组手术时间、术中出血量、切口长度，切口甲级愈合率和皮瓣成活面积百分比均明显优于股外侧组 （P<0.05），但是股深动脉组的皮瓣面积显著小于股外侧组 （P<0.05）。随访时间 12 个月以上。两组开始主运动活动时间、完全负重时间、TAM 功能评分比较差异均无统计学意义 （P>0.05）。［结论］ 相较于股前外侧皮瓣，采用游离股深动脉穿支皮瓣修复前臂创伤性皮肤缺损具有安全、简便、高效的应用优势，可有效降低手术时间、术中出血量。

Abstract:

[Objective] To evaluated the clinical outcomes of free deep femoral artery perforator flap used to repair traumatic soft tissue defects of hand and forearm by comparison with the anterolateral femoral flap. [Methods] A retrospective study was conducted on 106 pa- tients who underwent surgical treatment for traumatic soft tissue defects of the hand and forearm in our hospital from February 2015 to Au- gust 2019. Of them, 56 patients received free deep femoral artery perforator flap for repairing (DAPF group) , while 50 patients received an- terolateral femoral flap (ALFF group) . The patients in the two groups were compared regarding to perioperative and follow-up data. [Results] The patients in both groups had operation completed successfully. The DAPF group was significantly superior to the ALFF group in terms of operation time, intraoperative blood loss, incision length, excellent healing rate of the wound and percentage of flap survival area (P＜0.05) , but the DAPF group had a significantly smaller flap area than the ALFF group (P＜0.05) . All the patients were followed up for more than 12 months. There were no statistically significant differences between the two groups regarding to the time to start active motion, the time to resume full- weight bearing activity, and the TAM function score (P＞0.05) . [Conclusion] The free deep femoral artery perfora- tor flaps for repairing traumatic soft tissue defects of the hand and forearm has the advantages of high safety, simplicity and efficiency, and does effectively reduce the operation time and intraoperative blood loss compared with the anterolateral femoral flap.