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Title: [Clinical effects of bilateral overlength anterolateral femoral perforator flaps connected in series or parallel in repairing large area of wounds in limbs].
Author: Liu SZ, Ju JH, Liu ZJ, Zhou R, Tang LF.
Journal: Zhonghua Shao Shang Za Zhi; 2021 Mar 20; 37(3):250-256. PubMed ID: 33706431.
Abstract:
Objective: To explore the clinical effects of bilateral overlength anterolateral femoral perforator flaps connected in series or parallel in repairing large area of wounds in limbs. Methods: From January 2017 to July 2019, 9 patients with large area of skin and soft tissue defects in limbs were admitted to the Departments of Hand Surgery and Foot and Ankle Surgery of Ruihua Affiliated Hospital of Soochow University, including 8 males and 1 female, aged 36 to 63 years. The retrospective cohort study was conducted. The wound areas of patients after debridement were 20 cm×15 cm to 30 cm×25 cm, and the wounds were repaired with bilateral overlength anterolateral femoral perforator flaps. One main artery defect in the receiving area of 4 patients was repaired with bilateral flaps connected in series. Two main artery defects in the receiving area of 5 patients were repaired with bilateral flaps connected in parallel. A total of 18 flaps were excised, and the area of a single flap ranged from 20 cm×8 cm to 46 cm×9 cm. The donor sites of 17 flaps were sutured directly, and the donor site of 1 flap was repaired with free full-thickness skin graft from hypogastrium. Harvesting time of flaps, survival condition of flaps after surgery, and wound healing time, and flap observation, two-point discrimination distance of flaps, functional recovery of joint and appearance of recipient site, and recovery of donor site during follow-up were recorded. Results: In this group of 9 patients, the flap harvesting time was 1.0 to 4.5 hours, and all the 18 flaps survived. The wound healing time of recipient site was 18 to 72 days after flap transplantation. They were followed up for 6 to 34 months. The shape of the recipient site was satisfactory, with no deep tissue infection such as osteomyelitis. Four flaps in 2 patients were bloated and were thinned in 6 months after operation; 4 flaps in 2 patients had skin pigmentation on the edge of the flap; the flap of one patient was scalded but healed by dressing change, with patchy scar being observed during follow-up. The rest of the flaps were soft, elastic, and painless with good blood supply. All the flaps restored with protective sensation, with only one point in two-point discrimination. Only linear scars remained in the donor sites of 17 flaps. All the limbs had good blood supply in the distal end of donor sites, and no restriction occurred in range of motion of knee joint and quadriceps muscle strength. Conclusions: The bilateral overlength anterolateral femoral perforator flaps connected in series or parallel have constant anatomy, reliable blood supply, and flexible combination. It is an ideal surgical method for repairing large area of skin and soft tissue defects in limbs at one time. 目的： 探讨游离双侧股前外侧超长穿支皮瓣串并联修复四肢大面积创面的临床效果。 方法： 2017年1月—2019年7月，苏州大学附属瑞华医院手外科与足踝外科收治9例四肢大面积皮肤软组织缺损患者，其中男8例、女1例，年龄36~63岁，行回顾性队列研究。本组患者清创/扩创后创面面积为20 cm×15 cm~30 cm×25 cm，采用双侧股前外侧超长穿支皮瓣修复。4例患者受区1条主干动脉缺损，行双侧皮瓣串联修复；5例患者受区2条主干动脉缺损，行双侧皮瓣并联修复。共切取18个皮瓣，单个皮瓣切取面积为20 cm×8 cm~46 cm×9 cm。17个皮瓣供区直接缝合，1个皮瓣供区游离移植下腹部全厚皮片覆盖。记录皮瓣切取耗时、术后皮瓣成活情况、创面愈合时间，随访时皮瓣情况、皮瓣两点辨别觉距离、受区关节功能恢复情况及外形、供区恢复情况。 结果： 本组患者皮瓣切取耗时为1.0~4.5 h，18个皮瓣均成活，皮瓣修复后至受区创面愈合时间为18~72 d。随访6~34个月，患者受区外形较佳，无骨髓炎等深部组织感染。2例患者4个皮瓣臃肿，术后6个月行皮瓣修整；2例患者4个皮瓣边缘出现色素沉着；1例患者皮瓣被烫伤，经换药后愈合，随访遗留斑片状瘢痕；其余皮瓣质地柔软，弹性好，无疼痛，血运良好。所有皮瓣均恢复保护性感觉，两点辨别觉均仅有1个点。17个皮瓣供区只遗留线性瘢痕。所有供区远端肢体血运正常，膝关节活动度及股四头肌肌力均无受限。 结论： 串并联形式的双侧股前外侧超长穿支皮瓣解剖恒定、血供可靠、组合方式灵活，是一次修复肢体巨大面积皮肤软组织缺损的较理想的手术方法。.

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