组织工程与重建外科杂志 ›› 2025, Vol. 21 ›› Issue (4): 337-.

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股前外侧游离皮瓣修复重度糖尿病足溃疡创面的应用观察 #br#

  

  • 出版日期:2025-08-01 发布日期:2025-09-08

Application of anterolateral thigh flap in repairing severe diabetic foot ulcers

  • Online:2025-08-01 Published:2025-09-08

摘要:

目的 探讨应用股前外侧游离皮瓣修复重度糖尿病足溃疡创面的临床效果。方法 自2019年1月至2023年9月,对收治的15例重度糖尿病足溃疡患者应用股前外侧游离皮瓣移植修复。创面面积4.0 cm×6.0 cm~8.0 cm×18.5 cm。术后予常规抗感染、抗凝、抗血管痉挛、控制血糖对症处理。术后随访 6~24个月,观察皮瓣外观、感觉、伤口愈合情况、溃疡有无复发、足部功能以及皮瓣供区情况。结果 本组中,皮瓣完全成活13例;部分成活1例,经积极伤口换药等对
症处理后溃疡愈合;术后72 h内坏死1例。术后随访发现,14例皮瓣成活病例足部皮瓣外形美观,两点辨别觉8~15 mm,未见溃疡复发,所有患者大腿供区伤口线性愈合,供区髋、膝关节活动未受影响。按Maryland足功能评分标准,14例皮瓣成活病例足部功能评分:优5例,良7例,可2例。结论 股前外侧游离皮瓣可有效修复重度糖尿病足溃疡创面,但需严格把握手术适应证,积极处理和控制并发症,否则皮瓣存在一定愈合不良甚至坏死风险。

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Abstract:

 Objective To explore the clinical effect of using free anterolateral thigh flaps (ALTF) to repair severe diabetic
foot ulcer wounds. Methods From January 2019 to September 2023,15 patients with severe diabetic foot ulcers were treated with free ALTF transplantation. The wound area ranged from 4.0 cm×6.0 cm to 8.0 cm×18.5 cm. Postoperatively, the patients received routine anti-infection, anticoagulation, anti-vascular spasm, and blood sugar control treatments. Follow-up was conducted for 6-24 months. The follow-up contents included flap appearance, sensation, wound healing, ulcer recurrence, foot function, and the condition of the donor area. Results Among the 15 cases,13 cases had complete flap survival,1 case had partial flap survival, and 1 case experienced necrosis within 72 hours after surgery. The case with partial flap survival healed after active wound dressing changes and symptomatic treatment. In the 14 cases with flap survival, the foot flaps had an aesthetically pleasing appearance, two-point discrimination ranged from 8 to 15 mm, and there was no recurrence of ulcers. The donor site in all patients healed linearly without affecting the range of motion of the hip and knee joints. According to the Maryland Foot Function Score, the foot function scores were as follows:5 cases rated excellent,7 cases rated good, and 2 cases rated fair. Conclusion The use of free anterolateral thigh flaps can effectively repair severe diabetic foot ulcers. However, strict control of surgical indications and active management and control of complications are necessary, otherwise, there is a certain risk of poor healing or even necrosis of the flap

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