关键词: 游离皮瓣, 手足皮肤软组织缺损, 显微外科技术, 超薄

Abstract: Objective  To investigate the clinical effect of using free ultra-thin anterolateral thigh perforator flap to repair the soft tissue defect of hand and foot.
Methods  From January 2017 to January 2019,33 cases of hand and foot soft tissue defects were repaired by free ultra-thin anterolateral femoral perforator flap.Flap perforators identified by ultrasonic doppler blood vessel,and as the center,according to the shape and size of defect in the wound,free ultrathin femoral anterolateral perforators flap design,taking the flap on the broad fascia,retain most broadly fascia,free flap to wear with vascular pedicle,keeping a small number of broad fascia 2cm×3cm.The skin flap was thinned,and the subcutaneous fat was cut off successively from the periphery to near the penetrating point of the vessel cutaneous branch.The subcutaneous fat around the skin flap could be cut off completely,and only the dermis was retained.The tissue 2-3cm around the penetrating point was not trimmed to prevent the damage of the perforator vessel.The blood supply of the flap was observed and free transplantation was performed to repair the wounds of hand and foot.
Results  None of the 33 patients had vascular crisis after surgery,and all the flaps survived.Among them,3 patients had epidermal necrosis of about 1.5cm×2.0cm at the distal flap on the 6th day after surgery,which healed after dressing change.All 33 patients were followed up for 6-24 months,with an average of 14 months.After the operation,the skin flap was soft in texture,with good elasticity and no bloatness,and the skin color was close to normal skin.The sensory function recovered well,and the two-point discrimination sensation was 4.0-6.0mm.The function and appearance of hands and feet recovered well.According to the trial standard score of upper limb partial function evaluation by Hand surgery Society of Chinese Medical Association,the average score was 91,among which 24 cases were excellent,8 cases were good,and 1 case was fair.The excellent and good rate was 96.9%(32/33).
Conclusion  The ultra-thin free anterolateral thigh perforator flap can be used to repair the defect of hand and foot soft tissue.The flap has a high survival rate,good shape and satisfactory curative effect.No need for reconstructive surgery.

Key words: free flap, skin and soft tissue defects of hands and feet, microsurgical techniques, ultra-thin