组合皮瓣修复小腿及足踝部大面积软组织缺损

目的 探讨应用组合皮瓣修复小腿及足踝部大面积软组织缺损的临床应用价值和手术技巧. 方法 2005年1月至2008年12月采用组合皮瓣移植治疗36例小腿及足踝部大面积软组织缺损患者,其中采用游离股前外侧肌皮瓣组合携带健侧胫后血管的单桥式皮瓣修复14例,游离股前外侧肌皮瓣组合腓肠神经营养血管皮瓣修复11例,游离背阔肌皮瓣组合带健侧胫后血管的单桥式皮瓣修复6例,游离胸脐皮瓣组合局部转移腓肠肌皮瓣修复3例,游离股前外侧穿支皮瓣组合游离胸脐皮瓣修复1例,游离股前外侧肌皮瓣、游离胸脐皮瓣分别组合携带顺、逆行健侧胫后血管的双桥式皮瓣修复1例. 结果 本组有3例术后出现血管危象并进行了血管探查,解除动脉危象后1例游离皮瓣成活,1例游离皮瓣边缘坏死经换药后创面愈合,另1例静脉栓塞探查术后游离皮瓣部分坏死.其余33例患者移植组织令部成活,创面一期修复,总成功率为97.2%(35/36).术后随访4～36个月,平均16个月,皮瓣质地柔软,外形良好,患肢足踝功能恢复满意. 结论 采用不同形式的组合皮瓣移植,为小腿及足踝部大面积软组织缺损的修复提供了一个可行且有效的技术方法 ,手术虽有一定风险,但可有效降低伤残率,恢复肢体功能,缩短疗程.

Repairing massive soft tissue defects below the knee with combined flaps

Objective To explore the clinical value of repairing massive soft tissue defects below the knee with diverse combined flaps. Methods From January 2005 to December 2008, 36 patients with massive soft tissue defects below the knee were treated with combined flaps, including free anterolateral thigh flaps in 14 cases and free latissimus dorsal muscular flaps in 6 cases (both combined with posterior tibial vascular single bridge flaps from the healthy limb), free anterolateral thigh flaps combined with local transferred saphe-nous neurocutaneous vascular flaps in 11 cases, free thoraco-umbilical flaps plus local transferred gastrocnemius muscular flaps in 3 cases, free anterolateral thigh perforator flap plus free thoraco-umbilical flap in 1 case, free anterolateral thigh flap and free thoraco-umbilical flap respectively combined with double bridge flaps using the both ends of posterior tibia] vessel from the healthy limb to form vascular pedicles in 1 case. Results In 33 cases, flaps survived completely and their wounds were healed primarily. Vessel exploration was carried out following vascular crisis in 3 cases. After the artery crisis was relieved, the free flap survived well in 1 case, 1 case experienced marginal necrosis because of the arterial thrombosis in and 1 case partial necrosis because of the vein thrombosis. The overall flap success rate was 97.2% (35/36) . Follow-ups for a mean of 16 (4 to 36) months showed that all the flaps survived with good quality and shape and the affected foot and ankle obtained good function. Conclusions It is a feasible and effective method to repair massive soft tissue defects below the knee using differently combined flaps. Although the surgery can be risky, the method can effectively reduce the rate of limb disability, restore the limb function and shorten the course of treatment.