小腿或足部软组织缺损伴骨、肌腱外露的显微外科修复

目的 报道小腿或足部软组织缺损伴骨、肌腱外露应用显微外科修复的临床效果。方法 采用6种类型的皮瓣进行修复30例，其中吻合血管的背阔肌皮瓣12例包括采用胸背血管-小腿腓肠血管吻合的3例、吻合血管的阔筋膜张肌皮瓣3例、股前外侧皮瓣1例、小腿外侧逆行岛状皮瓣l例、小腿内侧岛状皮瓣l例、腓肠神经营养血管逆行岛状皮瓣12例。结果 吻合血管的肌皮瓣、皮瓣移植16例全部成活。14例岛状皮瓣除4例腓肠神经营养血管逆行岛状皮瓣远端小部分坏死外，其余均成活。术后随访l～4年，修复小腿软组织缺损10例的功能与外观均较满意。修复足部20例，其中涉及足跟、足底负重区12例包括4例全足皮肤脱套伤，均恢复了行走功能。结论 小腿、足部软组织缺损伴骨、肌腱外露、骨髓炎患，应用显微外科修复可取得较满意的效果。最佳手术方案的制定，精细熟练的显微手术，血管危象的防治是手术成功的关键。

Microsurgical repair of soft tissue defects at leg or foot with bone and tendon exposure

Objective To report the clinical effects of applying micro surgical technique in treatment of soft tissue defects at the leg or foot with hone and tendon exposure.Methods 30 cases were treated with 6 kinds of flaps.The latissimua dorsi myocutaneous flaps were adopted in 12 cases,in 3 of which llie dorsal thoracic vessels were anastomosed with surul vessels in the leg.In 3 cases the tensor fascia lata myocutaneous free flaps were used There were 1 unlerulateral femoral flap,1 dislully based lateral calf flap,1 distally based island flap,and 12 reverse island flaps supplied with nutritive vessels around the sural nerve.Results All the 16 cases of free muscular flaps and skin flaps survived.Of the 14 island flaps,most were successful,but 4 supplied with nutritive vessels around the sural nerve suffered slight necrosis at the distal part.After I to 4 years' follow-up,10 cases of repaired leg had satisfactory function and appearance.20 cases of repaired foot restored walking ability,including 12 foot injuries at heel and sole and 4 degloved skin injuries of the whole foot.Conclusion Soft tissue defects at the leg or foot with bone and tendon exposure or osteomyelitis could be treated with microsurgical repair and achieve satisfactory effects.The key to the success lies in optimal operative planning,skilled mierosurgeon and prevention of the vascular crisis.