目的

探讨携带阔筋膜的游离股前外侧穿支皮瓣（ALTPF）修复足踝复合软组织缺损的临床效果。

方法

自2017年1月至2022年1月，选取佛山市高明区人民医院对合并骨或肌腱外露软组织缺损15例足踝部损伤患者，软组织缺损面积（5.0×7.0）cm²～（9.5×15.0）cm²，应用携带阔筋膜的游离ALTPF修复。出院后门诊或微信随访，随访内容为皮瓣外观、颜色、感觉、足踝部功能恢复情况以及供区情况。

结果

本组15例游离ALTPF均成活，2例皮瓣于术后48 h发现血管危象，经急诊探查后皮瓣最终成活。本组病例术后均获得随访，随访时间为10～18个月，平均（12.0±0.6）个月，门诊随访10例，微信随访5例。15例皮瓣外形良好，无明显色素沉着，皮瓣质地柔韧，不影响踝关节活动，皮瓣两点分辨觉9～12 mm，平均（9.00±0.20）mm。患足功能根据美国足与踝关节协会（AOFAS）踝-后足评分，优10例，良5例。皮瓣供区均愈合良好，13例皮瓣供区均一期缝合，线性愈合，2例皮瓣供区无法直接缝合，取游离皮片植皮后供区愈合，供区大腿无明显肌力减退。

结论

携带阔筋膜的游离ALTPF移植修复足踝部复合组织缺损，皮瓣可切取面积大，质地柔韧，可早期行功能锻炼，踝关节功能恢复良好，供区损伤较小，适合临床推广。

Objective

To investigate the clinical effect of free anteriolateral thigh perforator flap with fascia lata to repair the complex soft tissue defect of foot and ankle.

Methods

From January 2017 to January 2022，the anterolateral femoral perforator flap wih fascia lata was used to repair the sof tissue defect in 15 cases of foot and ankle injury in Foshan Gaoming District People's Hospital . The soft tissue defect area was （5.0×7.0） cm² to （9.5×15.0） cm². After discharge，the patients were followed up in outpatient clinic or wechat， including the appearance color， sensation of the flap， functional recovery of the foot and ankle and the donor site.

Results

All 15 cases of free anteriolateral thigh perforator flaps survived， two cases of flaps were found vascular crisis 48 h after operation， the flaps suvived after emergency investigation. All the cases were followed up for 10 to 18 months， with an average follow-up time of （12.0±0.6） months. 10 cases were followed up in outpatient department and five cases were followed up on Wechat. The 15 cases had good appearance， no obvious pigmentation soft texture of the flap， nor influence on ankle joint movement .The two-point resolution of the flap was nine to 12 mm， with an average of （9.00±0.20） mm. According to the AOFAS ankle-hind foot score， 10 cases were excellent and five cases were good. The donor site of the skin flap healed well， 13 cases of the donor area were sutured linearly， two cases of the donor area could not be sutured directly， and the donor site healed after free skin graft ，there was no obvious muscle loss in the thigh of the donorsite.

Conclusion

Free anteriolateral thigh perforator flap with fascia lata can be transplanted to repair the complex tissue defect of foot and ankle， the flap can be cut with large area， flexible texture， early functional exercise good ankle function recovery， little damage in the donor site， and suitable for clinical.