吻合大隐静脉的逆行缝匠肌带蒂肌皮瓣临床应用

目的总结吻合大隐静脉的逆行缝匠肌带蒂肌皮瓣临床应用结果。方法2008年5月至2012年1月,应用吻合大隐静脉的逆行缝匠肌带蒂肌皮瓣修复16例（男10例,女6例）膝和小腿上1／3软组织缺损,年龄21～52岁,平均38岁。其中,膝关节周围缺损11例,小腿上1／3缺损5例。供区均为同侧。结果2例术后发生浅表感染,经临床换药逐渐愈合。肌皮瓣全部成活,随访1～3．5年,平均2．5年,取得了较满意的效果。没有发现明显的供区功能障碍。结论逆行缝匠肌带蒂肌皮瓣的大隐静脉与小隐静脉吻合,肌皮瓣的静脉回流呈正常方向,降低了肌皮瓣的部分坏死。     

腓肠内侧动脉穿支带蒂岛状皮瓣临床应用分析

目的分析腓肠内侧动脉穿支带蒂岛状皮瓣修复小腿上2／3软组织缺损的临床应用效果。方法自2003年5月～2008年1月,应用腓肠内侧动脉穿支带蒂岛状皮瓣修复22例膝和小腿上2／3软组织缺损,年龄20～53岁,平均35岁。其中,膝关节周围8例,小腿上2／314例。供区均选用同侧小腿。结果2例术后发生表浅感染,经更换敷料逐渐愈合,皮瓣全部成活,取得了较满意的效果。没有发现明显的供区功能障碍。结论该皮瓣以腓肠内侧动脉的肌皮穿支为血供,具有血供丰富、血管解剖恒定、血管蒂长以及皮瓣较薄的优点,带蒂岛状移植适宜修复膝和小腿上2／3软组织缺损。     

Healing Heel Ulcers in High-Risk Patients: Distally Based Peroneus Brevis Muscle Flap Case Series

The purpose of this study was to demonstrate use of a distally based peroneus brevis muscle flap in high-risk patients with diabetes and peripheral vascular disease for limb salvage of nonhealing heel ulcerations. Seventeen patients were referred for a below-knee amputation because of nonhealing heel ulcerations and peripheral vascular disease. As a last resort, 17 distally based peroneus brevis muscle flaps were elevated in 17 patients with full-thickness heel ulcerations measuring an average defect size of 14.11 cm2. All flaps were supplemented with concentrated bone marrow aspirate, negative pressure wound therapy, bilayer wound matrix, and static external fixation for an average time of 10.3 weeks. Split-thickness skin graft was delayed by an average of 17.5 days. All procedures were performed on patients diagnosed with diabetes, advanced peripheral arterial disease and a nonhealing heel ulcer present >1 year. All flaps survived at 1.5 years follow-up. The average time to healing was 10.3 weeks. No major amputations were performed to date. Partial tip necrosis occurred in 2 patients and healed uneventfully with local wound care. Distally based peroneus brevis muscle flaps in patients with diabetes and peripheral vascular disease offer a reliable alternative to limb salvage for full-thickness heel ulcerations measuring up to 7?×?6 cm. Combinatorial procedures are necessary to improve outcomes in high-risk patients whose alternative is a major amputation.     

小腿岛状穿支蒂螺旋桨皮瓣与股前外侧皮瓣修复足踝部复合组织缺损对比分析

目的:比较小腿岛状穿支蒂螺旋桨皮瓣与股前外侧皮瓣修复足踝部复合组织缺损的疗效.方法:按照随机数字表法将2019年1月-12月笔者医院收治的40例足踝部复合组织缺损患者分为A组与B组,每组20例.A组患者采用小腿岛状穿支蒂螺旋桨皮瓣进行修复,B组患者采用股前外侧皮瓣进行修复,术后随访12个月.比较两组的手术时间、皮瓣愈合...     

3D-CTA辅助下采用游离腓动脉穿支皮瓣修复前足皮肤软组织缺损创面的临床疗效

探讨对前足皮肤软组织缺损创面在3D-CTA辅助下采用游离腓动脉穿支皮瓣修复的效果。方法 选择2021年2月-2022年6月山东大学附属威海市立医院收治的48例前足皮肤软组织缺损患者为研究对照,以随机数字表法分为对照组和观察组,每组24例。对照组接受蒂皮瓣修补法治疗,观察组接受3D-CTA辅助下游离腓动脉穿支皮瓣修复法治疗,比较两组临床疗效、疼痛程度及足功能。结果 观察组治疗总有效率为95.83%,高于对照组的75.00%（P＜0.05）;观察组治疗后AOFAS评分高于对照组,VAS评分低于对照组（P ＜0.05）。结论 对前足皮肤软组织缺损创面在3D-CTA辅助下采用游离腓动脉穿支皮瓣修复的效果良好,可促进患者皮瓣感觉功能恢复,减轻术后疼痛,有利于改善患者的足功能,促进恢复。【关键词】3D-CTA;腓动脉穿支皮瓣;皮肤软组织缺损;足功能     

腓肠内侧动脉带蒂肌瓣的临床应用与改进

目的总结改进的腓肠内侧动脉带蒂肌瓣的临床应用结果。方法用此方法修复18例胫前区和膝关节周围软组织缺损。其中，胫骨上1／3软组织缺损6例，中1／3缺损5例，膝关节区7例。肌瓣表面行一期中厚网孔状游离植皮，供区直接缝合。结果肌瓣和其上植皮全部成活，受区外形较好，没有发现明显的供区功能障碍，取得了较满意的效果。2例术后发生表浅感染，经换药后愈合。结论该肌瓣以腓肠内侧动脉为血供，具有血供丰富、血管解剖恒定、血管蒂长以及肌瓣较薄等优点，带蒂移植适宜修复小腿上2／3和膝关节区软组织缺损。     

腓动脉踝上穿支皮瓣修复足部及踝部软组织缺损

目的报道以远端为蒂的腓动脉穿支皮瓣修复足背踝部软组织缺损。方法11例足背及踝部软组织缺损,采用远端为蒂的外踝上皮瓣进行修复,皮瓣面积最大19 cm×9 cm,最小5 cm×4 cm。结果11例皮瓣完全存活,随访时间2~21个月,皮瓣质地优良,外观及功能满意。结论远端为蒂的腓动脉穿支皮瓣是修复足背部软组织缺损的一种良好方法,该皮瓣具有血管恒定,切取方便,血供丰富且不需牺牲主要动脉的优点。     

应用各种皮瓣修复手背部软组织缺损

目的 总结各种带蒂皮瓣修复手背部软组织缺损的疗效及适应证。方法 根据手背部软组织缺损的面积及部位，对56例手背部软组织缺损患采用各种带蒂皮瓣修复。结果 53例皮瓣完全成活，3例出现皮缘部分坏死，8例需二期手术修整。结论 采用各种带蒂皮瓣修复手背部软组织缺损，方法简单、可靠，但要掌握一定适应证。     

Heel Coverage Using a Distally Based Sural Artery Fasciocutaneous Cross-leg Flap: Report of a Small Series

One of the goals in the management of severe open injuries of the foot is to obtain adequate soft tissue coverage. In extreme conditions of pedal soft tissue loss, in patients who are not satisfactory candidates for local or free-tissue transfer, the cross-leg flap remains an option for surgical reconstruction. We present the results of 7 patients with multiple lower limb open fractures associated with ipsilateral degloving injuries, and/or secondary pressure ulcers of the hindfoot with exposure of the calcaneus, in which a distally based sural artery island fasciocutaneous flap, elevated from the contralateral leg and crossed to the injured side, was used to repair the soft tissue defect of the recipient heel. All of the flaps survived and the soft tissues healed uneventfully, thereby providing satisfactory and stable coverage of the calcaneal tuberosity. To the best of our knowledge, this is the first report in which this technique has been used to repair hindfoot soft tissue defects associated with complex bone and vascular injuries of the lower limb in polytrauma patients. Level of Clinical Evidence: 4.     

逆行岛状腓动脉穿支皮瓣修复足后跟部软组织缺损

目的探讨逆行岛状腓动脉穿支皮瓣修复足后跟部软组织缺损的临床疗效。方法应用逆行岛状腓动脉穿支皮瓣修复15例足后跟部软组织缺损患者。受区创面面积4 cm×5 cm^6 cm×12 cm,皮瓣设计面积5 cm×6 cm^7 cm×13 cm。结果患者均获得随访,时间3个月~2年。15例皮瓣全部成活,皮瓣色泽、弹性好,外形美观,踝关节功能恢复好,患者满意。结论应用逆行岛状腓动脉穿支皮瓣修复足后跟部软组织缺损皮瓣血供可靠,外形与质地良好,手术操作简单,是修复足后跟软组织缺损的可靠方法。     

胫前软组织缺损的皮瓣修复(附56例报告)

目的：探讨胫前软组织缺损的修复方法及临床效果，方法：对56例创伤，慢性溃疡及瘢痕癌等原因所致胫前软组织缺损采用6种皮瓣进行局部转位，交腿移植，游离移植及桥式游离移植修复，结果：除一例失败外，其余皮瓣均成活，颜色及外形均较满意，无一例截肢，结论：根据不同的创面选择相应的皮瓣修复胫前软组织缺损，可最大限度地恢复小腿外形及功能。     

扩张后胸三角皮瓣带蒂转移修复术治疗面颈部烧伤后瘢痕的临床效果

目的 分析面颈部烧伤后瘢痕采用扩张后胸三角皮瓣带蒂转移修复术对术后修复组织挛缩率与疼 痛程度的影响。方法 选取武警河北总队医院与河北医科大学第一医院2019年2月-2023年6月收治的60例面 颈部烧伤后瘢痕患者为研究对象,采用随机数字表法分为对照组和观察组,各30例。对照组予以游离皮片 移植手术治疗,观察组予以扩张后胸三角皮瓣带蒂转移修复术治疗,比较两组修复组织挛缩率、修复效 果、并发症发生情况及疼痛程度。结果 观察组术后1、6个月修复组织挛缩率低于对照组（P ＜0.05）;观 察组修复后组织表面平整、皮肤色泽、感觉恢复、弹性质地、整体美观感评分均高于对照组（P ＜0.05）; 观察组并发症发生率低于对照组（P＜0.05）;观察组术后1、6个月VAS评分低于对照组（P＜0.05）。结论 扩张后胸三角皮瓣带蒂转移修复术用于面颈部烧伤后瘢痕治疗中能够改善修复效果,降低术后疼痛程度及 并发症发生几率,降低术后修复组织挛缩发生几率,在临床中应用价值较高。     

股前外侧游离皮瓣修复在足部皮肤软组织缺损治疗中的临床效果

探究股前外侧游离皮瓣修复在足部皮肤软组织缺损治疗中的临床效果。方法 选取2021年1月-2023年5月遵义市播州区人民医院收治的40例足部皮肤软组织缺损患者,依据手术方法不同将其分为对照组和观察组,各20例。对照组行传统带蒂皮瓣修复,观察组行股前外侧游离皮瓣修复,比较两组临床指标、皮瓣成活率、足部功能恢复情况。结果 观察组术中出血量少于对照组,手术时间、住院时间短于对照组,外形满意度高于对照组（P ＜0.05）;观察组皮瓣成活率高于对照组（P ＜0.05）;观察组AOFAS各维度评分高于对照组（P ＜0.05）。结论 在足部皮肤软组织缺损治疗中,实施股前外侧游离皮瓣修复效果确切,可有效减少术中出血量,缩短手术时间和住院时间,提高外形满意度和皮瓣成活率,促进足部功能恢复。     

Peroneus Brevis flap in Achilles tendon reconstruction. Clinical,radiological and functional analysis

BackgroundWe would like to describe our experience with Peroneus Brevis flap in complicated Achilles tendon re-ruptures with fringed stumps.MethodsEight patients with monolateral re-rupture of Achilles tendon were selected as eligible for surgical repair with Peroneus Brevis flap. Patients’ outcome was evaluated clinically (ATRS and ROM), functionally (Gait analysis) and MRI was performed before and after surgery.ResultsEffective coverage of tissue defect was reached in all patients. Functional assessment evaluation results were registered in a follow-up time that ranged from 12 to 18 months. ATRS and ROM tests’ results showed good functional recovery without functional limitations or subjective reports pain. Post-operative MRI showed no signs of inflammation or tissue gaps. Gait analysis showed a partial reduction of performance in the affected side that did not affect patients’ quality of life.ConclusionsIn the presence of fringed stumps in Achilles tendon re-rupture, tendon flaps have the benefits of autologous tissues transfers and present less risks of failure than free flaps. Among them, Peroneus Brevis flap is easy to perform and leads to donor site’s low morbidity. Our preliminary experience provides support for this technique to be potentially validated in larger more controlled trial.     

Distally Based Pedicled Fibula Flap for Reconstruction of Infected Charcot’s Midtarsal Collapse—Diabetic Rocker Bottom Foot

Introduction and Methods  Diabetic rocker bottom foot with secondary infection exacts the expertise of a reconstructive surgeon to salvage the foot. The author selected 28 diabetic patients with secondarily infected Charcot’s degenerated rocker bottom feet and reconstructed their feet using distally based pedicled fibula flap. Reconstruction was done in a staged manner. Stage 1 surgery involved external fixation following debridement. In stage 2, struts were activated for distraction and arthroereisis. In stage 3, the distally based pedicled fibula was used for reconstruction and beaming of the arches. Results  In this retrospective study, the author analyzed the outcome of all 28 patients using the Musculoskeletal Tumor Society Rating (MSTSR) score. The average MSTSR score was 27.536 in an average follow-up of 30.5 months. The limb salvage rate with the author’s procedure was 96.4% ( p = 0.045). Conclusion  Author’s protocol for the staged reconstruction and salvage of the infected diabetic rocker bottom foot, using the pedicled fibula flap, will be a new addendum in the reconstructive armamentarium of the orthoplastic approach.     

游离股前外侧皮瓣治疗小儿足踝部严重软组织损伤

目的 探讨游离股前外侧皮瓣修复小儿足踝部严重软组织缺损的临床经验.方法 1997年2月至2012年1月对16例小儿足踝部严重软组织缺损应用吻合血管的股前外侧皮瓣修复,并对手术方式、手术时机及疗效进行分析.结果 16例患儿移植皮瓣顺利成活12例,术后于24～48 h内发生动脉性血管危象4例,经取栓切取对侧大隐静脉移植后2例成活,但仍有2例出现皮瓣坏死.结论 游离股前外侧皮瓣移植是修复小儿足踝部严重软组织缺损的一种良好的选择,熟悉小儿游离皮瓣移植的特点,可获得满意的治疗效果.