摘要目的 探讨应用游离双侧股前外侧穿支皮瓣串联修复足踝部大面积软组织缺损的临床疗效.方法 自2013年7月至2017年12月共收治30例足踝部大面积软组织缺损患者,男19例,女11例;年龄21～52岁.缺损均位于足踝部及小腿中远段,创面均合并骨、肌腱或内固定物外露,缺损面积15 cm×22 cm～19 cm×28 cm,均采用游离双侧股前外侧穿支皮瓣串联修复.术前采用CDU或DSA检查确定双侧皮瓣穿支血管部位,以此为中心,根据软组织缺损面积及创面形状,于双侧大腿股前外侧区域分别设计一适宜面积及形状的穿支皮瓣,其中一侧穿支皮瓣作为近侧串联皮瓣,近端血管蒂与受区动、静脉相吻合,另一侧穿支皮瓣作为远侧串联皮瓣,两侧皮瓣之间动、静脉相吻合.所取两处皮瓣面积总和大小为17 cm×25 cm～23 cm×32 cm.术后定期随访,观察皮瓣成活情况及修复部位的功能恢复情况,并评价临床效果.结果 术后均未出现血管危象,皮瓣均成活.随访5～28个月,平均13.5个月,皮瓣血运良好,质地柔软,弹性好,其中4例皮瓣略显臃肿,经皮瓣整形后均得以改善.术后患者足踝部功能AOFAS评分,优秀(90～100分)26例,良(75～89分)4例,AOFAS平均分为93.8分.结论 应用游离双侧股前外侧穿支皮瓣串联修复足踝部大面积软组织缺损临床疗效良好.

abstractsObjective To investigate the clinical effect of free bilateral anterolateral femoral perforator flap in repairing large area soft tissue defects of foot and ankle. Methods From July, 2013 to December, 2017, 30 pa-tients (19 males and 11 females) with large soft tissue defects of ankle and foot were treated , aged 21-52 years. The defects were located in the middle and distal part of the foot and ankle, the wounds were all exposed with bone, ten-don or internal fixator, and the area of skin defect was 15 cm × 22 cm-19 cm× 28 cm. All of them were repaired by free bilateral anterolateral femoral perforator flaps. The perforating branch of bilateral flap was determined by CDU or DSA before operation. According to the area of skin defect and the shape of wound, an appropriate perforating branch flap was designed in the anterolateral thigh region. One perforating branch flap was used as the proximal series flap, the proximal vessel pedicle was anastomosed with the recipient region arteriovenous flap. The other perforating branch flap was used as the distal series flap, the artery and vein were anastomosed between the two flaps. The total area of the two flaps was 17 cm × 25 cm-23 cm × 32 cm. The survival of the flap and the functional recovery of the repair site were observed and the clinical effect was evaluated. Results There was no vascular crisis after operation, and the flaps survived. Followed-up for 5-28(mean, 13.5)months showed that the flap had good blood flow, soft texture and good elasticity, among which 4 cases were slightly bloated and improved after plastic operation. After operation, 26 cases were excellent (90-100 points), 4 cases were good (75-89 points), and the average score of AOFAS was 93.8 points. Conclusion The traffic accident of anterolateral perforating branch and the attention in the process of flap cutting and series were summarized.