小腿内侧皮瓣联合内侧半比目鱼肌瓣桥式带蒂转移术治疗对侧小腿软组织缺损

目的探讨小腿内侧皮瓣联合内侧半比目鱼肌瓣桥式带蒂转移术治疗对侧小腿软组织缺损的疗效。方法回顾性分析2012年1月至2016年1月甘肃省兰州市兰州手足外科医院骨科收治的8例小腿软组织缺损患者资料。男5例,女3例;年龄19~50岁,平均35岁。所有患者均以胫后动脉为蒂小腿内侧皮瓣联合内侧半比目鱼肌瓣桥式带蒂转移术治疗。软组织缺损的范围为10 cm×9 cm^13 cm×8 cm。肌瓣和血管蒂表面行一期中厚网状游离植皮,供区直接缝合。末次随访时按Iowa等提出的胫骨骨折疗效评定方法评定疗效。结果术后所有患者的皮瓣和肌瓣全部成活,没有发生血管危象。有1例患者发生肌瓣远端小块植皮坏死,经2周换药处理自然愈合。术后所有患者获2.5~4.5年(平均3.8年)随访。受区外形较好。末次随访时按Iowa等提出的胫骨骨折疗效评定方法评定疗效:优3例,良4例,可1例。结论小腿内侧皮瓣联合内侧半比目鱼肌瓣桥式带蒂转移术适用于治疗小腿仅有1条主要血管的软组织缺损,可减轻供区损伤。

Pedicled bridge transplantation for soft tissue defects at the contrallateral leg with medial leg skin flap and medial hemi-soleus muscle flap

Objective To evaluate the pedicled bridge transplantation with medial leg skin flap and medial hemi-soleus muscle flap for the treatment of soft tissue defects at the contrallateral leg.Methods Between January of 2012 and January of 2016,8 patients with soft tissue defects at the leg were treated at Department of Orthopedic Surgery,Hand and Foot Surgery Hospital of Lanzhou.They were 5 men and 3 women,aged from 19 to 50 years(mean,35 years).All of them were treated by bridge transplantation with medial leg skin flap and medial hemi-soleus muscle flap pedicled with posterior tibial artery.The size of the defects ranged from 10 cm×9 cm to 13 cm×8 cm.The immediate coverage of the muscle flaps and vessel pedicle was repaired by a meshed split-thickness skin graft.The donor site was closed directly.The therapeutic efficacy was assessed at the final follow-up according to the criteria by Iowa for tibial fractures.Results All the skin flaps and muscle flaps survived without any vascular crisis.One case developed necrosis of small skin graft at the distal muscle flap which spontaneously healed after dressing change for 2 weeks.Their follow-up ranged from 2.5 to 4.5 years(mean,3.8 years).A good contour was confirmed at the recipient area.By the Iowa criteria at the final follow-up,3 cases were excellent,4 good and one fair.Conclusion Pedicled bridge transplantation with medial leg skin flap and medial hemi-soleus muscle flap is a good treatment for soft tissue defects at the contrallateral leg which has only one major blood vessel,reducing damage to the donor site.