逆行股前外侧皮瓣移位修复胫骨外露创面

目的探讨逆行股前外侧皮瓣、肌皮瓣修复小腿中上段胫骨外露创面的方法及疗效。方法 2005年10月-2010年4月,应用逆行股前外侧皮瓣、肌皮瓣移位修复小腿中上段胫骨外露创面16例。男10例,女6例;年龄16～52岁。交通事故伤11例,重物压伤5例。10例为伤后1～6 h入院,平均3 h;6例伤后于外院行胫骨骨折钢板内固定术后创面严重感染,伤后至该次入院时间为6～14 d,平均10 d。创面范围13 cm×7 cm～20 cm×13 cm。皮瓣切取范围16 cm×10 cm～23 cm×15 cm。供区取中厚皮游离移植修复。结果术后5～7 d 2例皮瓣发生感染,经换药1周后愈合;其余皮瓣成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合,植皮成活。患者均获随访,随访时间10～23个月,平均18个月。患肢皮瓣外形稍臃肿,色泽、质地满意。骨折均于术后8～10个月愈合。结论采用逆行股前外侧皮瓣、肌皮瓣可有效修复小腿中上段胫骨外露创面。

Reverse anterolateral thigh flap for repair of wound defects with exposed tibia

Objective To investigate the method and effectiveness of reverse anterolateral thigh flap and muscle flap for repair of wound defects with exposed tibia in the proximal-middle leg.Methods Between October 2005 and April 2010,16 patients with wound defects with exposed tibia in the proximal-middle leg were treated with reverse anterolateral thigh flap and muscle flap.There were 10 males and 6 females,aged from 16 to 52 years.Injury was caused by traffic accident in 11 cases and by crushing in 5 cases.The disease duration of 1-6 hours(mean,3 hours) in 10 patients and 6-14 days(mean,10 days) in 6 patients,who underwent tibial fracture plate fixation in other hospitals.The size of wound ranged from 13 cm × 7 cm to 20 cm × 13 cm.The size of the flap ranged from 16 cm × 10 cm to 23 cm × 15 cm.The donor sites were covered with splite thickness skin grafts.Results Infection occurred in 2 flaps at 5-7 days and was cured after 1 week of dressing change;the other flaps survived and the wounds healed by first intention.The incisions healed well and the skin grafts survived at the donor sites.All cases were followed up 10-23 months(mean,18 months).The appearance of the flap was slightly overstaffed,but the color and texture were satisfactory.All fractures healed at 8-10 months after operation.Conclusion It is effective to repair wound defects with exposed tibia in the proximal-middle leg with reverse anterolateral thigh flap and muscle flap.