带髂胫束股前外侧穿支皮瓣修复足踝后区组织缺损

目的探讨应用带髂胫束股前外侧穿支皮瓣在足踝后区皮肤、跟腱缺损修复重建中的临床效果。方法 2013年7月-2015年10月收治足踝后区皮肤、跟腱组织复合缺损23例,均采用带髂胫束股前外侧穿支皮瓣修复,同时重建跟腱的缺损。其中男19例,女4例;年龄13～57岁。皮肤缺损范围11 cm×5 cm～33 cm×10 cm,跟腱缺损长度4～13 cm。急诊修复6例,Ⅱ期手术17例。结果 21例皮瓣全部成活,1例皮瓣术后出现静脉回流障碍;1例皮瓣下血肿形成,导致局部皮肤组织坏死,经换药、植皮手术后创面愈合。21例术后随访3个月～2年,皮瓣外形满意,跟腱抗应力性能好。根据AOFAS踝-后足评分,足踝功能恢复良好。结论应用带髂胫束股前外侧穿支皮瓣修复足踝后区皮肤、跟腱的缺损,临床效果满意。     

吻合血管髂胫束移植修复跟腱缺损

目的探讨带血管的髂胫束游离移植修复跟腱缺损的术式及疗效. 方法在解剖观测髂胫束的血供来源及膝上外侧动脉的起源、走行、分支、分布及吻合的基础上,进行手术设计.1999年9月～2003年1月应用吻合血管的髂胫束修复长段跟腱缺损6例,其中单纯跟腱缺损4例,复合跟腱缺损2例,缺损长度6～11 cm. 结果膝上外侧动脉起自动脉,向外上走行分为升、降支.升支发出肌支和髂胫束穿支;膝上外侧动脉升支与膝最上外侧动脉在股外侧肌内吻合后穿出股外侧肌形成肌皮穿支.降支发出肌支、3～5支股骨外侧髁骨膜支及髂胫束穿支.术后供、受区创面均一期愈合.随访6个月～3年8个月个月,Thompson征阴性,双、单足提踵试验阴性.无跟腱再断裂、跟区皮肤破溃等并发症发生. 结论根据膝上外侧血管的分支、分布及吻合特点,吻合血管的髂胫束游离移植是修复跟腱缺损的一种较好的治疗方法.     

股前外侧筋膜皮瓣修复跟腱开放性缺损

目的探讨股前外侧筋膜皮瓣修复跟腱部皮肤软组织缺损,同时采用改良方法缝合髂胫束重建跟腱的疗效。方法 2009年10月-2011年6月,收治10例跟腱开放性缺损患者。男7例,女3例;年龄5～60岁,中位年龄40岁。致伤原因:轮辐伤5例,重物砸伤3例,交通事故伤2例。伤后至入院时间2～24 h,平均8 h。创面范围11 cm×7 cm～18 cm×10 cm;跟腱缺损长度4～10 cm,平均7 cm。3例合并跟骨结节缺损。入院后行急诊清创、封闭式负压引流治疗5～7 d后,应用大小为11 cm×7 cm～20 cm×12 cm的股前外侧筋膜皮瓣移植修复皮肤软组织缺损,同时采用改良方法缝合髂胫束重建跟腱。皮瓣供区直接拉拢缝合或植皮修复。结果术后皮瓣及供区植皮均成活,创面均Ⅰ期愈合。患者均获随访,随访时间6～18个月,平均10个月。皮瓣质地柔软,有弹性;3例皮瓣外形稍臃肿,其余皮瓣外形良好。末次随访时,皮瓣两点辨别觉为2～4 cm,平均3 cm。患者行走正常,患侧踝关节背伸活动范围(24.40±2.17)°,与健侧(25.90±2.33)°比较,差异无统计学意义(t=1.591,P=0.129);跖屈活动范围为(44.00±1.94)°,与健侧(45.60±1.84)°比较,差异无统计学意义(t=1.735,P=0.100)。踝关节功能按Arner-Lindhoim评定法评定均为优。结论应用股前外侧筋膜皮瓣修复跟腱部皮肤软组织缺损,同时采用改良方法缝合髂胫束重建跟腱,术后能早期关节功能锻炼,有利于踝关节功能恢复。     

背阔肌皮瓣游离移植修复下肢巨大软组织缺损

目的探讨背阔肌皮瓣游离移植修复足跟合并小腿或足底、足背巨大软组织缺损的临床效果。方法1998年3月~2005年5月,采用背阔肌皮瓣游离移植修复10例足跟合并小腿或足底、足背软组织缺损的巨大创面。其中男9例,女1例,年龄32~60岁。病程:2h~2个月。耕田机损伤5例,交通事故伤2例,毒蛇咬伤2例,电击伤1例。其中足跟后侧合并小腿后侧皮肤、腓肠肌及跟腱不同程度缺损8例,缺损范围21cm×12cm~35cm×15cm;足跟合并足底、足背和踝部皮肤软组织缺损2例,缺损分别为27cm×14cm和30cm×21cm。均合并骨外露,6例合并骨折,2例合并胫后血管及胫神经损伤,4例合并踝关节开放感染。切取背阔肌皮瓣25cm×14cm~33cm×24cm,其中1例背阔肌皮瓣达38cm×18cm。供区均采用大张中厚皮片移植覆盖。结果术后10例背阔肌皮瓣全部成活,无血管危象和感染发生,创面均期愈合。术后获随访3~24个月,其中5例皮瓣外形臃肿,影响穿鞋,二期行皮瓣修薄整形术;重建感觉的5例患者3例恢复保护性感觉,2例胫神经损伤患者足底痛、温觉恢复,足内在肌功能无明显恢复;5例桥接腓肠肌的背阔肌肌力恢复至级,踝关节功能部分恢复。无继发溃疡发生,所有患者均恢复负重与行走功能。3例供区植皮部分坏死,其中2例经换药后治愈,1例二期植皮修复,余供区植皮均成活。结论背阔肌皮瓣血运丰富,切取范围大,肌瓣可填塞死腔,抗感染能力强,是修复足跟合并邻近巨大皮肤软组织缺损和骨外露感染创面的一种理想皮瓣。     

股前外侧皮瓣转移修复四肢软组织缺损27例

随着显微外科的日益发展 ,使大面积软组织缺损依靠皮瓣转移而得到一期修复。本院 3年来应用股前外侧皮瓣转移修复手掌部皮肤缺损 9例 ,手背部皮肤缺损 7例 ,内踝处 6例 ,外踝处 3例 ,胫前 1例 ,窝部 1例 ,最大面积 17cm×12 cm,最小面积 8cm× 5 cm。 2 5例一次成功 ,1例因皮肤边缘部分坏死 ,经多次清创 ,换药后痊愈。 1例因私自吸烟导致血管痉挛 ,经处理后痊愈。治疗效果满意。本皮瓣优点是可以一期修复较大面积的皮肤缺损 ,最大可达 37cm× 12 cm。本院修复的最大缺损面积为 17cm× 12 cm。皮瓣厚薄相对适中 ,美观 ,功能良好 ,血管径粗…     

带旋髂浅血管蒂腹股沟骨皮瓣移位修复手部骨皮肤缺损

目的探讨带旋髂浅血管蒂髂腹股沟骨皮瓣移位修复手部复合组织缺损的疗效。方法1998年2月~2004年5月,收治急诊入院的33例手部皮肤软组织缺损合并骨缺损。其中男22例,女11例。年龄19~54岁,平均24.3岁。手掌贯穿伤17例,手背部电刨伤9例,其他损伤7例。其中合并掌骨缺损23例,指骨缺损10例。皮肤缺损范围3.5cm×2.0cm~15.0cm×10.0cm;骨缺损1.5~4.2cm。清创3~7d后应用以旋髂浅动、静脉为皮瓣轴型血管蒂的骨(骨膜蒂)皮瓣进行修复,皮瓣切取范围4.0cm×2.5cm~17.0cm×11.0cm。结果术后骨皮瓣全部成活,创面期愈合31例,期愈合2例。随访4~22个月,平均8.2个月,皮瓣质地良好,外观及功能满意。骨缺损达临床愈合时间5~9周,平均7周。结论带旋髂浅血管蒂髂腹股沟骨皮瓣切取简便、血供丰富,供区隐蔽,且均能直接缝合,是修复手部复合组织缺损的一种较理想的方法。     

膝上外侧动脉穿支髂胫束皮瓣修复腘窝软组织缺损

目的总结膝上外侧动脉穿支髂胫束皮瓣修复腘窝软组织缺损的疗效。方法 2009年1月-2011年8月,收治9例腘窝软组织缺损患者。男5例,女4例;年龄24～53岁,平均35.2岁。交通事故伤5例,热压伤2例,绞伤2例。新鲜创面3例,陈旧创面6例;伤后距皮瓣修复术8～24 d。软组织缺损范围5 cm×3 cm～15 cm×8 cm。采用大小为7 cm×4 cm～20 cm×8 cm的膝上外侧动脉穿支髂胫束皮瓣移位修复创面。供区直接缝合或游离植皮修复。结果术后3例皮瓣远端坏死,对症处理后成活;其余皮瓣及供区植皮均顺利成活,创面Ⅰ期愈合。9例均获随访,随访时间8个月～2年3个月,平均1年7个月。腘窝外形良好,膝关节屈曲120～140°,伸直—5～0°。结论膝上外侧动脉穿支髂胫束皮瓣位置隐蔽,无需显露膝上外侧血管蒂,皮肤较薄,血供可靠,可切取面积较大,适用于腘窝软组织缺损的修复。     

游离股前外侧穿支皮瓣修复胫前皮肤软组织缺损

目的探讨应用游离股前外侧穿支皮瓣移植修复胫前皮肤、软组织缺损的临床效果。方法对14例胫前皮肤、软组织缺损伴骨外露患者,应用游离股前外侧穿支皮瓣移植修复,皮瓣切取面积14cm×6cm～23cm×12cm,供区直接缝合或以全厚皮片植皮修复。结果术后14例皮瓣全部存活,创面一期愈合,术后随访3～24个月(平均8个月),皮瓣质地优良,无溃疡发生,8例获保护性感觉,骨折愈合后下肢可负重行走。结论股前外侧穿支皮瓣是修复胫前皮肤、软组织缺损的有效方法。     

头颈部肿瘤术后缺损游离组织瓣的供区选择

目的应用游离组织瓣修复头颈部肿瘤术后缺损,探讨较简便合适的方法。方法回顾并分析1999年1月~2002年1月,采用游离组织瓣修复头颈部肿瘤术后缺损86例。缺损部位:口腔32例,下咽27例,下颌骨12例,颅底5例,中面部4例和头皮/皮肤6例。供区:腹直肌皮瓣32例,股前外侧皮瓣10例,空肠瓣25例,腓骨瓣11例,背阔肌皮瓣4例,前臂皮瓣3例和肩胛皮瓣1例。其中皮瓣或肌皮瓣大小4 cm×5 cm~14 cm×24 cm,腓骨瓣长度4~16 cm,空肠瓣长度9~20 cm。结果游离组织瓣术后成活79例,成活率为92%。其中口腔缺损采用腹直肌肌皮瓣22例(69%)和股前外侧皮瓣10例(31%)修复;下咽缺损主要用空肠瓣修复25例(93%),下颌骨缺损则用腓骨瓣修复11例(92%),颅底缺损由腹直肌皮瓣修复4例(80%)。腹直肌、股前外侧、空肠和腓骨4种组织瓣修复头颈部缺损78例,占同期游离组织瓣的91%。结论头颈部肿瘤术后缺损复杂,利用腹直肌肌皮瓣、股前外侧皮瓣、空肠瓣和腓骨瓣可解决大多数修复重建的难题。     

游离股前外侧皮瓣的临床应用

目的探讨游离股前外侧皮瓣移植修复四肢皮肤缺损的临床效果。方法采用吻合血管的股前外侧皮瓣游离移植修复足背皮肤缺损11例,小腿骨外露5例,手背及虎口皮肤缺损4例;皮瓣切取面积10cm×8cm~22cm×10cm。结果20例皮瓣全部成活,术后随访6~48个月,移植皮瓣外形及功能恢复满意。结论股前外侧皮瓣具有切取面积大、部位隐蔽、不损伤主要血管、血管蒂长等优点,是修复四肢皮肤缺损较理想的方法。     

Reconstruction of the Achilles tendon and overlying soft tissue by free composite anterolateral thigh flap with vascularized fascia lata

Segmental loss of the Achilles tendon with overlying soft tissue and skin defect remains a complex reconstructive challenge. Successful reconstruction combines tendon repair with coverage of the defect by soft tissue flaps, creating an entity that meets up to three predetermined goals: (1) approaching preinjury functionality, (2) resisting shearing forces, and (3) achieving an esthetic result. From June 2009 to June 2011, our center submitted six patients to a one-stage procedure correcting the Achilles tendon using a composite free anterolateral thigh (ALT) flap with vascularized fascia lata. The flap sizes ranged from 5 to 8 cm in width and 16 to 20 cm in length and all flaps included vascularized fascia lata which was rolled to serve as an Achilles tendon. After reconstruction our patients showed good functional results, these patients could walk, climb stairs, and tiptoe again without support. Moreover, normal footwear could be worn. A free composite ALT flap with vascularized fascia lata is a reliable option for coverage of Achilles tendon and overlying soft tissue defects, even in elderly patients.     

陈旧性跟腱断裂合并皮肤缺损的一期修复

陈旧性跟腱断裂合并皮肤缺损的治疗较为复杂，常规治疗应在局部创面愈合后３个月行二期跟腱修复。１９８５年６月～１９９６年６月采用自体肌腱或筋膜瓣移植修复跟腱，同时用伤肢邻近带血管、神经蒂岛状皮瓣覆盖，石膏托外固定，治疗陈旧性跟腱断裂合并皮肤缺损１８例。结果表明，创面Ⅰ期愈合１６例，移植皮瓣远端皮缘坏死０．５ｃｍ～１ｃｍ的２例，经早期修复治愈。术后１年以上随访１５例，其中１２例关节功能恢复正常，３例跟腱与邻近组织粘连，影响踝关节过度背屈，足部蹬力下降。认为，采用肌腱或筋膜瓣加带血管神经蒂岛状皮瓣一期修复陈旧性跟腱断裂合并皮肤缺损，可缩短疗程，减轻患者的痛苦和经济负担，更快恢复伤肢的功能     

One-stage reconstruction of soft tissue and Achilles tendon defects using a composite free anterolateral thigh flap with vascularized fascia lata: clinical experience and functional assessment

The combined loss of the Achilles tendon with overlying soft tissue is a reconstructive challenge. To achieve acceptable rehabilitation, such patients need skin coverage including functional repair of the Achilles tendon. This article presents four such patients who were treated successfully by means of an anterolateral thigh (ALT) composite flap with vascularized fascia lata. The size of the ALT flaps ranged from 10 to 16 cm in length and 6 to 9 cm in width. All flaps included vascularized fascia lata, which was rolled to serve as vascularized tendon graft (range 8 x 6 cm to 10 x 8 cm) for reconstruction of the Achilles tendon defect. Flap success rate was 100%. All patients could walk and climb stairs without support; however, mild difficulty when running was reported. Functional outcome of the recipient ankle and donor thigh morbidity were investigated by using a kinetic dynamometer comparing reconstructed sides with the healthy contralateral limbs. This assessment was performed in two patients at 2 years postoperatively. In the reconstructed ankles, isokinetic concentric measurements of dorsiflexion and plantar flexion showed a deficit of 30% and 40%, respectively. Functional evaluation of quadriceps femoris muscle contraction forces after free ALT composite flap harvest showed a 10% to 25% deficit. However, there were no difficulties in daily ambulating. In summary, the free composite ALT flap with vascularized fascia lata provides an alternative option for Achilles tendon reconstruction in complex defects.     

Reconstruction of Achilles tendon defect with a free quadriceps bone-tendon graft without anastamosis

We report a method of Achilles tendon reconstruction using a free quadriceps bone-tendon graft. The patient had a prior repair of a re-ruptured Achilles tendon, following which he developed massive necrosis of his skin and Achilles tendon leaving a 10 cm defect. First stage reconstruction consisted of soft tissue coverage of the skin defect with a sural fasciocutaneous flap. Reconstruction of the Achilles tendon followed, with the patellar bone block fixed to the calcaneus and the quadriceps tendon sutured proximally.     

Reconstruction of the severe Achilles tendon and soft-tissue loss with the bi-pedicled conjoined flap and vascularized fasciae latae: A consecutive case series of 15 patients

BackgroundHistorically, the segmental loss of the Achilles tendon with overlying soft-tissue defects had been frequently reconstructed with the composite anterolateral thigh (ALTP) flap, including the iliotibial tract or fasciae latae. This study aimed to present our modified combination using the bi-pedicled conjoined flap with vascularized fasciae latae, for the approximately total reconstruction of the Achilles tendon and extensive soft tissue.MethodsFrom May 2015 to March 2018, 15 patients (9 male and 6 female) with a mean age of 36 years (ranged, 18–52 years) underwent microvascular Achilles tendon reconstruction. Harvested on the abdomen and groin, the conjoined flap was chimeric with the vascularized fasciae latae. Primary donor-site closure was accomplished in all patients. A standard assessment of the functional and esthetical outcomes was completed.ResultsMean follow-up time was 42 months (ranged, 32–48 months). The average dimension of the conjoined flap was 25 × 14 cm (ranged, 18 × 10–35 × 18 cm), and the average size of the folded fasciae latae was 15 × 6 cm (ranged, 12 × 5–25 × 8 cm). At the last follow-up, the Thompson test was negative in all patients. The mean American Orthopedic Foot and Ankle Society (AOFAS) score was 91.0. The mean Achilles tendon total rupture score (ATRS) was 18.5. The mean Vancouver Scar Scale (VSS) score was 3.0.ConclusionsThe composite bi-pedicled flap including vascularized fasciae latae provides an alternative approach with great functional and esthetic outcomes, in selected patients who suffered severe Achilles tendon and skin defects. The one-stage procedure facilitates better rehabilitation postoperatively.     

游离腹直肌瓣加植皮修复小腿及足踝部软组织缺损

目的探讨应用游离腹直肌瓣加中厚游离植皮修复小腿和足踝部软组织缺损的方法和疗效.方法 1998年5月～2002年12月,采用以腹壁下动、静脉为蒂的一侧腹直肌瓣游离移植加中厚植皮修复2例小腿、9例足踝部因外伤所致软组织缺损伴有骨、肌腱外露及骨髓炎患者.病程为1个月～10年.缺损范围3 cm×4 cm～8 cm×14 cm;切取腹直肌瓣4 cm×6 cm～8 cm×15 cm.结果术后11例移植肌瓣均成活,8例创口Ⅰ期愈合,3例移植中厚皮片坏死经再植皮后愈合.11例术后获随访6个月～4年,外形及功能良好.结论游离腹直肌瓣加中厚游离植皮修复小腿与足踝部软组织缺损具有血运好、抗感染力强和顺应性好等优点,可用于填充缺损及修复不规则创面,术后外形良好,克服了肌皮瓣肥厚臃肿的缺点.     

带髂胫束的逆行股前外侧皮瓣修复髌前复合组织缺损并重建髌韧带

目的：探讨带髂胫束的逆行股前外侧皮瓣修复髌前复合组织缺损并重建髌韧带的效果。方法对2007年3月—2011年8月收治的髌前软组织并髌骨缺损的16例患者,采用带髂胫束的逆行股前外侧皮瓣移植修复并重建髌韧带,皮瓣切取范围7.5 cm＆#215;10.5 cm～8.5 cm＆#215;13.5 cm,髂胫束切取长度7.0～13.0 cm,宽度5.0～7.0 cm,随访时间6个月～3年。结果16例患者皮瓣均成活,优9例,良5例,可2例。结论带髂胫束的逆行股前外侧皮瓣修复髌前复合组织缺损并重建髌韧带的方法是修复髌前软组织并髌骨缺损的一种有效术式。     

游离股前外侧穿支皮瓣修复足前端缺损

目的:探讨应用股前外侧穿支皮瓣修复足远端缺损的效果。方法:切取股前外侧穿支皮瓣,皮瓣切取面积为8cm×16cm~15cm×18cm。供区直接缝合或断层皮片移植修复,与足背动静脉吻合,修复足前端缺损15例。结果:15例患者皮瓣均完全成活,其中4例出现静脉危象,经探查修复后缓解,患者恢复行走功能,避免了截肢。结论:股前外侧穿支皮瓣股前外侧皮瓣供区隐蔽,简便实用,是修复足远端缺损的理想选择。