摘要目的 探讨旋股外侧动脉斜支穿支的供血范围及观察斜支穿支皮瓣的临床应用效果. 方法 2014年1月至2016年1月,在大腿前外侧区设计切取了57块皮瓣,发现携带旋股外侧动脉斜支穿支者21例(占37％),术中观察了斜支、降支供应股外侧肌表面皮肤范围,其中12例采用斜支穿支皮瓣覆盖足、踝部创面.男8例,女4例;年龄23～52岁.交通事故伤6例,重物挤压伤4例,器械伤2例.损伤部位:足背5例,踝部4例,小腿远端3例.伤后至首次就诊时间4～36 h,平均16h.单纯穿支皮瓣6例,携带阔筋膜、股外侧肌复合组织瓣4例,分叶皮瓣2例.术中切取大小为7 cm×11 cm～8 cm×21 cm的旋股外侧动脉斜支皮瓣游离移植修复缺损,供区直接缝合. 结果 根据斜支、降支供应股外侧肌表面范围,分为Ⅰ型(降支为主型)16例、Ⅱ型(斜支降支均匀型)2例、Ⅲ型(斜支为主型)3例.所有皮瓣完全成活,供区一期愈合11例,伤口少许裂开1例,经换药痊愈,残留一斜线瘢痕、无牵拉不适,周围感觉麻木范围减小.供瓣区髋膝关节早期肌力减退3例,3个月后逐渐好转,半年后无异常不适.12例获电话随诊时间3个月～2年,平均13个月,所修复四肢功能良好,皮瓣质地饱满,色泽与周围皮肤无异,外形无挛缩,恢复保护性感觉,供区可见纵行线状瘢痕,无局部疼痛及触觉过敏现象. 结论 股外侧肌表面皮肤软组织血供具有多样性,设计、切取股前外侧皮瓣时应小心鉴别.旋股外侧动脉斜支穿支皮瓣手术简单、可靠,也可切取多种形式的穿支皮瓣.

abstractsObjective This study revisits the blood supply of the oblique branches in the light of recent advances in the understanding of tbe vascular anatomy of the anterolateral thigh,and observes its clinical application effect.Methods From January,2014 to January,2016,a prospective intraoperative observational study was performed in 57 consecutive anterolateral thigh flaps,noting the dimensions and locations of the oblique and descending branches and the number and size of the muscle branches supplying the rectus femoris.Twenty-one patients were found with the oblique and descending branches and performed the free flap pedicled with collateral branch of oblique rarus of lateral circumflex femoral artery to fix the foot and ankle in 12 cases.There were 8 males and 4 females with an age range from 23 to 52 years.They were injuried by traffic accident (6 cases),by object hit from height (4 cases),or hurted by machines (2 cases).The locations were foot in 5 cases,ankle in 4 cases,and at the distal shank in 3 cases.The disease duration was 4 hours to 36 hours (mean,16 hours).Six skin flaps,4 fascia flap plus skin flap,2 ramified flaps harvest were then completed as planned.The size of flaps ranged from 7 cm × 11 cm to 8 cm × 21 cm,and the donor sites were closed directly in all cases.Results On the basis of the dimensions and locations of the oblique and descending branches supplying the rectus femoris,all cases were devided into type Ⅰ (descending branche,16 cases),type Ⅱ (the oblique and descending branche,2 cases),type Ⅲ (oblique branche,3 cases).After operation,all the flaps survived,while wound dehiscence accured in 1 case and healed after dressing change and left a slash residual scar without pulling discomfort.The donor site was accompanied by a decrease in the range of peripheral sensory numbness.Early muscle strength of hip and knee arised in 3 cases,got better in 3 months and dispeared in 6 months.By way of telephone follow-up,12 patients were followed for 3-24 months (mean,13 months).The appearance and function of the tissue flaps were satisfactory,only linear scar was observed at the donor site,which had less damage and no effect on walking.Conclusion Blood vessels should be carefully identified,while flaps are harvested with diversity of blood supply.As it is improved that the oblique branch of lateral circumflex femoral artery perforator tissue flap is simple and reliable,also can perform various forms of perforator flaps.