胫骨皮瓣游离移植修复小腿创伤性骨和皮肤缺损

目的探讨应用胫骨皮瓣游离移植一期修复小腿严重创伤性骨与皮肤缺损，免除截肢的治疗方法。方法对12例小腿创伤性骨与皮肤缺损采用胫骨皮瓣游离移植进行治疗。一期重建患肢胫骨支架连续性及覆盖创面。皮瓣最长17cm，最宽10cm；骨瓣最长12cm。结果术后随访最短6个月，最长5年，皮瓣血运良好，术后2个月内均见骨瓣开始生长，术后3—5个月移植骨均达骨性愈合，平均愈合时间为15周，累及的炎症得到完全控制，修复的肢体功能、外形令人满意。结论胫骨皮瓣具有解剖标志清楚、骨膜较厚、血供丰富、血管蒂多、供骨量大、皮瓣面积大、位置表浅、手术操作有较大的灵活性等优点，治疗小腿严重创伤性骨皮缺损可一次完成骨架重建及创面覆盖，有利于肢体功能的尽早恢复。

Repairation of bone and skin defect in leg with vascularized tibial bone-skin flap graft

Objective To evaluate the efficacy of tibial bone-skin flap grafts in the management of severe traumatic osteomyelitis complicated with bone and skin defect in leg to avoid amputation. Methods From March 1998 to Aug. 2004, 12 cases of the traumatic osteomyelitis complicated with bone and skin defect in leg were treated with vascularized tibial bone-skin flap graft. The longest flap was 17cm, widethest 10cm, The longest bone flap was 12cm. They were followed up for 0. 6 to 5 years. Results All the tibial bone-skin flaps survived completely, 2 cases of osteomyelitis recurred. The followed-up, from 0. 5 to five years, showed good bone union in all cases, averageing 15 weeks. The infection was under control. The leg function and contour were satisfactory. Conclusion The tibial bone-skin flap has the advantages of having distinguished sign of anatomy, highly vascularized, easy to obtain, simply and flexible procedure, improving circulation, shortens hospitalization and suitable for treatment of traumatic osteomyelitis complicated with bone and skin defect in leg.