跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损

Objective To study the clinical effect of iliac flap straddled donor area to primary repair large defect of bone and soft tissue. Methods Through the anatomical study about iliac flap, the new oper-ation method about iliac flap was designed, which straddled donor area and used one blood vessel stem (deep iliae circumflex artery) and two branch blood vessel(deep iliac circumflex artery and superficial iliac circum-flex artery compounding in series) for blood supply. Blood supply area of the analogical operation was stud-ied by irrigating fresh cadaver with Indian ink. Thirty-two patients with large defect of bone and soft tissue (20 males, 12 females, 17-68 years old, average 36 years old) were repaired by this method, and the hemo-dynamics was studied by laser Doppler flowmetry. Results It was feasible to connect superficial iliac cir-cumflex artery with the branch of deep iliac circumflex artery. Indian ink irrigating fresh cadaver simulate operation showed that area scope dyed by Indian ink: in ilium, Indian ink was found in the bone which was (15.8±3.2) cm away from anterior superior iliac spine. In skin flap, Indian ink was found (8.6±2.4) cm superi-or, (5.4±2.6) cm inferior, (5.8±2.6) cm internal and (24.6±5.8) cm external from the anterior superior iliac spine. Laser Doppler flowmetry showed that the peripheral blood flow of skin flap increased as time passed, the increase speed began to tardy at the third day, then ingress the platform stage. Thirty-two cases were all succeed with functional rehabilitation and perfect shape. Thirty-one cases got completely bone healing; bone healing time ranged from 9 to 19 months, with an average of 12 months. One case turned to chronic os-teomyelitis, and had to suffer operation again, the bone healing time was 22 months. Conclusion As the ili-ae flap straddled donor area has sufficient blood supply, it can repair large defect of bone and soft tissue in one stage.     

跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损

Objective To study the clinical effect of iliac flap straddled donor area to primary repair large defect of bone and soft tissue. Methods Through the anatomical study about iliac flap, the new oper-ation method about iliac flap was designed, which straddled donor area and used one blood vessel stem (deep iliae circumflex artery) and two branch blood vessel(deep iliac circumflex artery and superficial iliac circum-flex artery compounding in series) for blood supply. Blood supply area of the analogical operation was stud-ied by irrigating fresh cadaver with Indian ink. Thirty-two patients with large defect of bone and soft tissue (20 males, 12 females, 17-68 years old, average 36 years old) were repaired by this method, and the hemo-dynamics was studied by laser Doppler flowmetry. Results It was feasible to connect superficial iliac cir-cumflex artery with the branch of deep iliac circumflex artery. Indian ink irrigating fresh cadaver simulate operation showed that area scope dyed by Indian ink: in ilium, Indian ink was found in the bone which was (15.8±3.2) cm away from anterior superior iliac spine. In skin flap, Indian ink was found (8.6±2.4) cm superi-or, (5.4±2.6) cm inferior, (5.8±2.6) cm internal and (24.6±5.8) cm external from the anterior superior iliac spine. Laser Doppler flowmetry showed that the peripheral blood flow of skin flap increased as time passed, the increase speed began to tardy at the third day, then ingress the platform stage. Thirty-two cases were all succeed with functional rehabilitation and perfect shape. Thirty-one cases got completely bone healing; bone healing time ranged from 9 to 19 months, with an average of 12 months. One case turned to chronic os-teomyelitis, and had to suffer operation again, the bone healing time was 22 months. Conclusion As the ili-ae flap straddled donor area has sufficient blood supply, it can repair large defect of bone and soft tissue in one stage.     

难治性股骨干骨不连的显微外科治疗

目的对近5年收治的15例难治性股骨干骨折骨不连进行总结，探讨难治性股骨干骨折骨不连的成因及显微外科治疗方法。方法分别采用带血管髂骨移植治疗13例，带血管腓骨移植治疗2例，其中使用外固定架治疗6例，钢板固定9例。结果15例中均7～15个月达到临床愈合，13例出现膝关节活动障碍，其中9例再次行膝关节松解术。结论带血管的髂骨及腓骨移植作为植入骨，治疗难治性股骨干骨不连效果较好，既有一定强度，又能尽快恢复血运。术中无创操作、尽量少剥离骨膜、采用合理的内固定物及膝关节功能练习是此类手术成功的关键。     

腓骨头复合组织瓣修复儿童内踝骨皮肤缺损四例

Objective To investigate the therapeutic effect of fibular head composite flap for bone and skin defect at medial malleolus in children. Methods From Aug. 2005 to Apr. 2009, 4 children cases(2 male, 2 famale, from 3 to 11 year) with bone and skin defect at medial malleolus were reconstructed with fibular head composite flaps pedicled with lateral inferior genicular vascular bundle. The skin defect was 3- 6 cm × 8-10 cm in size. Results All the 4 compostie flaps survived completely. The patients were followed up for 4 months to 4 years with good bony healing. Both esthetic and functional results were satisfactory in ankle joint. Conclusions The fibular head composite tissue flap has a good therapeutic effect for bone and skin defect at medial malleolus in children.     

跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损

Objective To study the clinical effect of iliac flap straddled donor area to primary repair large defect of bone and soft tissue. Methods Through the anatomical study about iliac flap, the new oper-ation method about iliac flap was designed, which straddled donor area and used one blood vessel stem (deep iliae circumflex artery) and two branch blood vessel(deep iliac circumflex artery and superficial iliac circum-flex artery compounding in series) for blood supply. Blood supply area of the analogical operation was stud-ied by irrigating fresh cadaver with Indian ink. Thirty-two patients with large defect of bone and soft tissue (20 males, 12 females, 17-68 years old, average 36 years old) were repaired by this method, and the hemo-dynamics was studied by laser Doppler flowmetry. Results It was feasible to connect superficial iliac cir-cumflex artery with the branch of deep iliac circumflex artery. Indian ink irrigating fresh cadaver simulate operation showed that area scope dyed by Indian ink: in ilium, Indian ink was found in the bone which was (15.8±3.2) cm away from anterior superior iliac spine. In skin flap, Indian ink was found (8.6±2.4) cm superi-or, (5.4±2.6) cm inferior, (5.8±2.6) cm internal and (24.6±5.8) cm external from the anterior superior iliac spine. Laser Doppler flowmetry showed that the peripheral blood flow of skin flap increased as time passed, the increase speed began to tardy at the third day, then ingress the platform stage. Thirty-two cases were all succeed with functional rehabilitation and perfect shape. Thirty-one cases got completely bone healing; bone healing time ranged from 9 to 19 months, with an average of 12 months. One case turned to chronic os-teomyelitis, and had to suffer operation again, the bone healing time was 22 months. Conclusion As the ili-ae flap straddled donor area has sufficient blood supply, it can repair large defect of bone and soft tissue in one stage.     

足骨及软组织损伤缺损的组合组织修复临床研究

目的 研究解决足部创伤及疾病造成的足骨及软组织缺损的修复重建方法，减少和减轻足残疾和功能不良率，最大限度的恢复足功能和外型。方法 对于足背、前足、足跟、踝下等部位单纯软组织缺损，可采用局部转移或旋转皮支皮瓣、筋膜皮瓣，游离皮瓣，游离全厚植皮等方法修复；足底负重区采用预制皮瓣方法解决；前足、足跟及其它跗骨复合组织缺损采用带血管髂骨加皮瓣组合移植重建；内外踝缺损应予以重建。结果 247例患者经1．5～5年随访，按美国AOFAS踝一足评分标准：优84例，良107例，可42例，差14例。结论 髂骨用于重建再造跖骨缺损尤其是多跖骨缺损、跟骨缺损，稳定且触地面积大、承压小；内外踝可取带筋膜的髂骨和腓骨头重建骨及韧带缺损；组合带血管骨与皮瓣修复缺损，可恢复足的解剖和生理功能。     

足部逆行岛状皮瓣修复(足母)趾骨外露创面

趾外伤后组织缺损常遗留难以直接缝合的创面 ,为闭合创面可选择趾 (跖 )骨缩短、交腿皮瓣、游离皮瓣移植等方法[1] 。我们应用足部岛状皮瓣 ,修复由于各种原因造成的第一趾 (跖 )骨外露 18例 ,闭合创面以保留第一趾 (跖 )长度 ,获得成功。1　资料与方法　　自 2 0 0 1年 2月 - 2 0 0 3年 4月共收治 18例趾外伤后组织缺损患者 ,男 12例 ,女 6例 ;年龄 6～ 4 6岁。第一足趾由于挤压伤脱套伤近节趾骨外露 9例 ,离断后第一跖趾关节外露4例 ,外伤术后背侧皮肤坏死造成趾骨外露 3例 ,甲瓣术后植皮坏死 2例。采用逆行第一跖背动脉皮瓣修复…     

带筋膜髂骨再造内踝骨与韧带缺损初步报告

目的 研究创伤造成的内踝部骨及软组织缺损再造及重建的方法。方法 采用(带血管)髂骨块携带筋膜条与局部岛状皮瓣或吻合血管的游离皮瓣组合移植同期或分期再造内踝骨、三角韧带及皮肤组织。结果 经采用髂骨重建内踝及韧带后，经11个月～2年随访，初步结果表明：踝关节的稳定性良好，内翻角与健侧基本相同，无侧方及前后的关节异常活动，1例行走轻度内翻、2例劳累后有疼痛，行走负重功能恢复满意，X线片显示游离植入髂骨无明显吸收及疏松。结论 内、外踝的完整性对踝关节功能有重要的影响，采用髂骨与皮瓣组合修复方法重建内踝缺损，可恢复踝关节的稳定性，获得满意功能。     

儿童内踝骨与皮肤缺损重建的中远期随访

目的探讨腓骨头复合组织瓣重建儿童内踝骨与皮肤缺损的中远期临床效果。方法对采用腓骨头复合组织瓣重建儿童内踝骨与皮肤缺损9例进行随访,随访时间3.5~8年,并对踝关节功能进行评价,对出现并发症的患者进行有效地治疗。结果所有患者均在校学习,能参加各项活动,双足发育未见明显差异;移植的腓骨头与内踝重建结合部均骨性愈合,随访期间未发生二次骨折;所有移植的腓骨头未出现骨骺闭合现象,移植腓骨头均出现同步生长现象。3例胫骨下端内侧骨骺出现不同程度的骨骺早闭,出现轻度的足内翻,对于较为严重的2例,1例行外侧骨骺阻滞术(9岁),1例行内侧植骨矫形术(14岁)。根据AOFAS中足评分标准对患足功能进行评定:优3例,良4例,可2例。结论腓骨头复合组织瓣是重建儿童内踝骨与皮肤缺损的一种较好方法,在发育过程中出现的并发症要及时治疗,可以达到良好的治疗效果。     

预制皮瓣修复足底负重区软组织缺损

目的　探讨用预制皮瓣修复足底负重区软组织损伤缺损的效果。方法　先于拟施皮瓣移植部位切取部分全厚皮片与健侧足心区相应大小皮片互换移植、打包构成含健侧足心皮片的预制皮瓣并做延迟移植。 3周后将该皮瓣移植于患足并使足心皮片部位于足底负重部位 ,同时从足跟骨跖面钻数个骨孔至两侧面 ,由皮瓣内壁缝线于骨孔内悬吊固定。使皮瓣与骨跖面贴切牢固 ,恢复足底垂直纤维纵隔结构。结果　 8例患者随访 15～ 2 3个月 ,负重行走良好 ,无溃疡 ,外形满意。根据美国 AOFAS足踝功能评分标准 :5例大于 80分 ,2例大于 75分 ,1例 70分。结论　利用健侧足心预制皮瓣可以较好地恢复足底创面 ,且耐磨、耐压 ,功能及感觉功能良好。解决一般组织瓣移植存在稳定性差 ,且发生溃疡及二次手术率高的难题