中华显微外科杂志2007年8月第30卷第4期ChinJMicrosurg,August,2007,Vol30,No.4旋股外侧动脉降支分叶肌皮瓣治疗肢体皮肤软组织缺损刘会仁刘德群李瑞国曹磊邵新中张艳茂项力源王国强孙来卿【摘要】目的探讨旋股外侧动脉降支为蒂的分叶肌皮瓣治疗肢体皮肤软组织缺损骨感染的临床效果。方法应用旋股外侧动脉降支为蒂,肌皮支形成股前外侧皮瓣、肌支形成股外侧肌瓣的分叶肌皮瓣游离移植,治疗四肢伴有骨关节感染、内固定外露的皮肤软组织缺损24例。结果术后23例肌皮瓣全部成活,1例坏死,行皮片移植术。I期愈合16例,Ⅱ期愈合8例。3例于伤口愈合后形成窦道,其中1例两次形成窦道,均行清创手术后窦道闭合,最长1年后伤口愈合。4例外伤后骨髓炎伴骨缺损,于伤口愈合后6~8个月行植骨术,伤口无感染,其中2例骨愈合。22例伤口愈合后随访6~20个月无再感染。结论旋股外侧动脉降支分叶肌皮瓣具有血管蒂长、腔隙填充完全、应用灵活、抗感染力强的特点,是治疗伴有骨感染的肢体皮肤软组织缺损较为理想的肌皮瓣。【关键词】肌皮瓣;移植;旋股外侧动脉;显微外科Treatmentofextremityinfectionswithsofttissuedefectswiththeramifiedmusculocutaneousflappedi·cledwiththedescendingbranchoflateralcircumflexfemoralarteryLIUHui—ren.L,De—qun.LIRui—guo,CAOLei,SHAOXin—zhong,ZHANGYan—mao,XIANGLi—yuan,WANGGuo—qiang,SUNLai—qing.De—partmentofHandSurgery.eSecondHospitalinTangshan.Tangshan063000.China【Abstract】ObjectiveTodiscusstheclinicaleffectoftheramifiedmuscul0cutaneOUSflappedicledwiththedescendingbranchoflateralcircumflexfemoralarterytreatmentofbonesandarthrsisofextremityin—fectionswithsofttissuedefects.MethodsThemuscleflapbloodedwiththemuscularbranchoflateralfem—oralmuscleandmusculocutaneousflapbloodedwiththemusculocutaneousbranchweredesigned.allofwhichwerepedicledwiththedescendingbranchoflateralcircumflexfemoralartery.Inclinic.24cases0fbonesandarthrosisofextremityinfectionswithsofttissuedefectsweretreatedwiththiskindoframifiedmusculocutaneousflap.ResultsOfthe24cases.23casesweresurvivedwhile1casewaslost.16caseswerehealedatstageI,8caseswerehealedatstageII.Sinushasformatedin3cases,oneofwhichtwice.buttheywerehealedinoneyearwiththetreatmentofdebridments.Fourcaseswithosteomyelitisandbonedefectweretreatedwithbonegraftinginthelater6~8monthsafterthewoundhashealed.Twenty—twocaseswerefollowed—uDfr6~20months,infectiondidn’trecur.ConclusionThiskindoframifiedmusculocutaneousflaphaSsuchad—vantagesaslongerbloodvesselpedicle,fillingthedefectscompletelyflexibleapplicationandstrongeranti—in—feetion,thatitmaybeaneffectivewayintreatingbonesandarthrosisesofextremityinfectionswithsofttissuedefects.【Keywords】Musculocutaneousflap;Transplantation;Lateralcircumflexfemoralartery:Micr0一surgery;高能量创伤致骨折肢体广泛皮肤软组织损伤术后组织坏死,遗留皮肤软组织缺损,骨、关节和内固定物外露,以及伤口感染骨髓炎,给治疗带来极大的困难。感染创面的覆盖成为治疗的关键问题。肌瓣和肌皮瓣血运丰富,是感染创面覆盖和深部腔隙填充的较好手基金项目:河北省科技厅基金资助项目(03276043D-29)作者单位:063000河北唐山市,唐山市第二医院手外科(刘会仁,刘德群,李瑞国,曹磊,张艳茂,项力源,王国强);河北医科大学附属第三医院(邵新中)·261··临床研究·段⋯。自2002年1月至2005年10月,我们应用旋股外侧动脉降支为蒂的分叶肌皮瓣治疗伴有骨关节感染、内固定外露的四肢皮肤软组织缺损24例,伤口全部愈合,取得良好的效果。报道如下。资料与方法一、一般资料本组24例,男22例,女2例,年龄20~54岁,平维普资讯http://www.cqvip.com均34岁。均为肢体开放伤术后,皮肤软组织缺损或坏死导致的骨关节及内固定外...