游离腓骨(皮)瓣移植修复上肢长段骨缺损

目的 探讨游离腓骨(皮)瓣移植修复上肢长段骨缺损的临床应用及效果.方法 自2000年6月至2010年12月,应用游离腓骨骨瓣修复上肢长段骨缺损12例,其中携带皮瓣4例.男11例,女1例；年龄19～ 55岁,平均35岁.修复肱骨缺损2例,尺骨缺损6例,桡骨缺损4例.腓骨瓣切取范围1.5 cm× 2.0 cm～ 12.0 cm× 16.0 cm,腓骨移植长度6.0～ 20.0 cm.结果 12例均成功并获得随访,随访时间平均2年5个月.4例携带皮瓣全部存活；创面Ⅰ期愈合11例,Ⅱ期愈合1例,愈合时间12～18 d；腓骨移植骨愈合时间3～6个月,平均4个月.应用Enneking上肢功能标准评分为22～29分,平均27分；供区无功能障碍.结论 游离腓骨(皮)瓣移植修复上肢长段骨缺损可一期完成骨缺损修复,且可同时解决软组织缺损.虽难度大、风险高,但仍是一种很理想的治疗方法.

Transplantation of the free fibular osteocutaneous flap for repair of long bone defect of the upper extremity

Objective To explore the clinical application and results of free fibular osteocutaneous flap transplantation for repair of long bone defect of the upper extremity.Methods From June 2000 to December 2010,free fibular bone flap was applied to repair long bone defect of the upper extremity in 12 cases,among which 4 cases had osteocutaneous flap.Of the 12 cases,there were 11 males and 1 female.Their ages ranged from 19 to 55 years old,with 35 years old on average.The fibular bone flap was used to repair humerus shaft bone defects in 2 cases,ulnar bone defects in 6 cases,and radius bone defects in 4 cases.The area of the cutaneous fibular flap ranged from 1.5 cm × 2.0 cm to 12.0 cm × 16.0 cm.The length of fibular bone flap ranged from 6.0 cm to 20.0 cm. Results All 12 cases were successfully follow-up.The mean follow-up duration was 2 years and 5 months.All 4 cutaneous flaps survived completely.Wounds healed in the primary attempt in 11 cases and in the secondary attempt in 1 case (healing time ranged from 12 to 18 days).Bone healing time ranged from 3 to 6 months (4 months on average) in fibula transplantation.The Enneking score system was applied to evaluate the upper extremity function.Of the 12 cases,the mean score was 27 (their scores ranged from 22 to 29).There was no functional impairment of the donor sites.Conclusion Despite the technical difficulty and risk,transplantation of the free fibular osteocutaneous flap is an optimal method to repair long bone defect of the upper extremity in that it can repair defects of the bone and soft tissue simultaneously.