目的 探讨游离股外侧肌瓣联合封闭式负压吸引技术（VSD）修复四肢软组织缺损的临床效果。 方法 2009年6月－2011年6月，对25例四肢软组织缺损患者采用游离股外侧肌瓣联合VSD治疗对创面经彻底清创后，先行VSD覆盖，5～9 d后去除VSD负压膜。再次清创受区，切取股外侧肌瓣修复创面，处理血管危象，二期植皮。 结果 25例均获得随访，时间6～12个月。经负压封闭引流后，局部创面无明显感染，肌腱及骨外露区周围肉芽组织生长良好。出现血管危象3例，经及时处理后3例肌瓣均恢复血液循环。感染控制良好，无窦道形成，患肢功能恢复满意。 结论 对于严重创伤后的肢体软组织缺损，经彻底清创后，应用封闭式负压引流及游离股外侧肌瓣修复，可明显缩短治疗周期，提高手术成功率，最大限度恢复患肢的功能。
Objective To evaluate the effectiveness of anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap for repairing extremities soft tissue defect. Methods Between January 2014 and January 2017, 24 patients with extremities soft tissue defects were treated by anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap. There were 15 males and 9 females, with a median age of 33.5 years (range, 5-64 years). Wounds located in upper limb in 8 cases, complicated with radial styloid fracture in 1 case, extensor tendon exposure in 3 cases, and brachioradialis muscle tendon exposed in 1 case. Wounds located in lower extremity in 16 cases, complicated with calcaneal or metatarsal, phalangeal fractures in 4 cases, Achilles tendon departure in 1 case, toe long extensor tendon and flexor digitorum longus tendon exposed in 8 cases. The wound area ranged from 8 cm×5 cm to 18 cm×12 cm. According to wound size, anterolateral thigh perforators were detected by conventional ultrasound Doppler (2-5 perforators). The irregular wounds were decomposed into multiple parts and the leaf number (2-4 leaves) of polyfoliate flap depended on the part number of the wound. The flap area ranged from 9 cm×6 cm to 20 cm×14 cm, and the largest area of single leaf was 24 cm×6 cm. The vascular pedicle length ranged from 7 cm to 12 cm. The foliate flap area with protecting pedicle ranged from 5 cm×3 cm to 7 cm×5 cm. Results All the flaps survived, and no vascular crisis occurred. All the patients were followed up 2-28 months (mean, 9 months). Sinus occurred in 1 case of calcaneal fracture after flap repair, and the sinus was healed after 3 months by conventional dressing. All the flaps were thin and had a good texture. Healing of soft tissue was found in 5 patients with fracture. The wrist and ankle plantar flexion and dorsiflexion function of recipient site were normal in all patients. Conclusion It is safe and reliable to repair the extremities soft tissue defect with anterolateral thigh polyfoliate perforator flap plus pedicle with one foliate flap. And it is one of the ways to reduce the vascular crisis of the anterolateral thigh free perforator flap.