目的 探讨应用游离股前外侧穿支嵌合阔筋膜瓣显微修复前臂背侧复合组织缺损并重建患肢背伸功能的方法和疗效.方法 回顾性分析2013年3月—2017年10月顺德和平外科医院收治前臂背侧中上段复合组织缺损患者5例,男性4例,女性1例;年龄18～54岁,平均30.8岁.机器绞伤3例,道路交通伤2例.软组织缺损面积15cm×8cm～24cm×12cm,均伴伸肌群部分缺失.手术切取对侧股前外侧皮瓣,将皮瓣下的阔筋膜全部携带依据伤情将阔筋膜编织成束,调整好张力之后重建伸腕、伸指功能,皮瓣切取范围较缺损面积放大10％(16cm×10cm～25cm×14cm,阔筋膜切取为皮瓣同等大小),供区游离植皮修复.结果 患者术后均皮瓣存活顺利,无血管危象及感染发生,其中1例患者供区游离植皮发生部分坏死,经换药愈合良好.术后随访12～48个月,平均22.4个月.末次随访患者皮瓣外形无臃肿,受区具有保护性感觉,伸腕及伸指功能恢复良好.结论 携带阔筋膜的股前外侧动脉穿支皮瓣修复前臂背侧复合组织缺损,一次手术既能修复创面又能对患肢背伸功能进行重建,可以获得比较理想的外观及功能,值得在此类损伤患者中推广应用.

Objective:To explore the application of the superficial iliac perforator flap (SCIP) based on the concept of "Donor site under swimming wear" in the repair of wounds of extremities.Methods:From June, 2018 to March, 2019, a total of 20 patients with traumatic soft tissue defects of the extremities were treated. All defects were repaired with free SCIP, including 16 males and 4 females. Location of defects: 10 in the hand, 4 in the forearm, 4 in the shank, and 2 in the foot. Wound areas were 7.3 cm×5.6 cm-16.3 cm×7.7 cm. Patients received routine CTA and high-frequency CDU examinations before surgery to assist in identifying the location of the perforating vessels and the running of the superficial and deep branches of the superficial iliac circumflex artery (SCIA). Combined intraoperative light transmission experiments were used to determine the dominant branch. The superficial branch of SCIA was used as the dominant branch in 18 cases, and the flap was cut in the superficial layer of Scarpa's fascia. The deep branch of SCIA was used as the dominant branch in 2 cases and the flap was cut in the superficial layer of the deep fascia. The donor site was directly sutured. Regular postoperative follow-ups were conducted without lost.Results:All flaps had no vascular crisis after surgery and survived successfully. All patients were followed-up regularly for 8 to 16 months, with an average of 12 months. At the last followed-up, the appearance and texture of the flaps in the recipient area were good, and roughly similar to the healthy tissues around the affected limb. The function of the affected limb recovered well. There was only a linear scar in the donor area.Conclusion:The SCIP based on the concept of "Donor site under swimming wear" is soft in texture, moderate in thickness, and concealed in the supply area. The patient can directly hide the scars of the donor areas after wearing the swimming trunks, which meets the concept of minimizing the damage to the donor area. It deserves to be promoted.