Single-stage reconstruction of mandibular and soft tissue defects using a free osteocutaneous groin flap

Microvascular reconstruction of the mandible and soft tissues using the composite groin flap is ideal in selected patients. No other available bone so closely approximates the mandible in both thickness and curvature as does the iliac crest. The soft tissues are available for reconstruction and may allow the surgeon to avoid a second flap, except in cases where both lining and cover are needed. The deep circumflex artery is of generous size, usually 2 to 2.5 mm in diameter, allowing greater reliability in the microvascular anastomoses. The flap has a fairly long vascular pedicle, 6 to 8 cm. The ability of this flap to withstand irradiation and infection because of its blood supply permits early institution of postoperative radiotherapy and prevents bone loss due to small intraoral wound dehisicence or total flap loss. Although the donor site requires extensive dissection, it can be closed primarily, eliminating the need for skin grafts or other flaps.As further experience is gained with this flap, both the functional and cosmetic results should be improved. In patients undergoing resection of the remaining portion of the mandible, the symphysis or the anterior portion of the mandible, a procedure of this type should be done primarily to prevent deformity and to minimize disability for the patient.     

足底内侧岛状皮瓣联合腹股沟游离皮瓣修复足跟部软组织缺损

目的探讨足底内侧岛状皮瓣联合腹股沟游离皮瓣修复足跟部皮肤软组织缺损的临床效果。方法回顾性分析2015年10月至2020年12月榆林市第二医院烧伤整形手足外科收治的足跟部皮肤软组织缺损患者的临床资料。患者经急诊清创或扩创后,应用足底内侧岛状皮瓣修复足跟部创面,腹股沟游离皮瓣修复足底内侧供区创面,腹股沟供区直接缝合。术后观察皮瓣血运及存活、皮瓣供区愈合情况,并对足跟外形与功能恢复情况进行随访。结果共纳入8例患者,男7例,女1例,年龄20~71岁,平均32.2岁。其中5例为足跟外伤,1例足跟鳞状细胞癌,1例足跟冻伤,1例足跟溃疡。足跟部创面面积4 cm×3 cm~7 cm×6 cm。手术过程顺利,足跟岛状皮瓣及腹股沟皮瓣切取范围较足跟创面扩大0.5~1.0 cm。8例患者术后皮瓣血运良好,创面均一期愈合。术后随访3~12个月,所有患者足跟弹性佳,外形无臃肿,耐磨、耐压,感觉及行走功能满意;足底内侧供区无凹陷,无瘢痕增生及挛缩,无局部皮肤溃疡;腹股沟供区仅见线性瘢痕。结论足底内侧岛状皮瓣联合腹股沟游离皮瓣修复足跟部缺损,足部外观及功能恢复良好,效果满意。     

Soft tissue and bone defects of the tibia. Treatment with pedicled muscle transfer and a microvascular anastomosed myocutaneous flap

The free tissue transfer by microvascular anastomoses has opened new dimensions in reconstructive surgery. However a free microvascular myocutaneous flap should only be used in case of a local pedicled flap being impossible. In treating complicated defects of soft tissue and bones a clear cut gradation of therapeutic steps has to be observed: 1. control of wound infection, 2. wound debridement, 3. soft tissue repair, 4. bone reconstruction.     

改良髂骨骨皮瓣游离移植治疗掌背复合组织缺损

目的总结游离改良的以旋髂浅动脉为蒂的髂骨骨皮瓣重建掌背骨与软组织缺损体会。方法2009年3月-2012年3月,应用骨皮瓣修复掌背复合组织缺损7例,平均年龄42．9岁。伤肢均为右手．合并不同程度伸肌腱损伤2例：合并腕骨骨折、脱位2例;掌指关节损伤3例;指骨骨折3例。受伤至再手术时间平均为18．6d。术后7d开始功能练习。定期复查,了解植骨愈合、关节活动度、握力大小、皮瓣感觉恢复及供区副损伤,完成患肢手臂肩残疾问卷表及供区可视疼痛评估表。结果本组皮瓣全部成活．5例甲级愈合,2例乙级愈合。平均骨愈合时间：植骨远端2．3个月,近端2．7个月。随访12～24个月,腕关节平均掌屈38．6°,背伸42．9°,尺偏21．4°,桡偏22．9°。受累掌指关节平均活动度35．7°。患侧平均握力13．9kg。3例皮瓣平均静态两点辨别觉13．7mm,余皮瓣仅恢复深触觉。平均手臂肩残疾问卷评分12．1分。所有患者术后2周可行走,术后3个月轻微疼痛1例,术后1年供区瘢痕平软,无疼痛。结论游离改良的以旋髂浅动脉为蒂的髂骨骨皮瓣可成功治疗掌背部骨与软组织缺损,供区损伤较小。     

Review of the free scapular flap: a versatile flap for most osteocutaneous tissue defects

Although there is little doubt that the scapular flap is a versatile flap that is suitable for most tissue defects, it has failed to gain its proper place in the reconstructive armamentarium. This may be due to the perceived donor site morbidity. However, many published articles have shown that the donor site morbidity is limited and acceptable. The scapular free flap is accessible, relatively easy to dissect and has a long vascular pedicle with a constant position of artery and veins. The donor site may be closed primarily for flaps that do not exceed 10 cm in width. It is usually hairless, and is ideal for intermediate-sized defects. There is no functional donor site deficit and the resulting scar is acceptable. No major artery is sacrificed. The independent arc of skin flap rotation relative to the bone component is another major advantage over other flaps. Therefore, I believe that the scapular free flap is a superior and adaptable flap in most skin and/or bone defect reconstructions.     

皮瓣结合外固定架治疗胫骨骨折伴小腿软组织缺损

[目的]探讨小腿软组织缺损伴有胫骨骨折或骨缺损的有效治疗方法，[方法]对5例小腿大面积软绀织缺损同时伴有胫骨骨折或骨缺损的病例，采用游离皮瓣腓肠神经营养血管皮瓣小腿内侧皮瓣等移植加外固定架结合的方法治疗，[结果]5例小腿创面均愈合，外同定架固定骨折在6～14个月内愈合，[结论]外同定架与皮瓣结合是治疗小腿大面积软组织缺损伴有骨折、骨缺损的一种良好办法。     

皮瓣联合外固定架治疗胫骨骨折伴小腿软组织缺损

目的 探讨小腿软组织缺损伴有胫骨骨折或骨缺损、骨髓炎的有效治疗方法。方法 对45例小腿大面积软组织缺损同时伴有胫骨骨折或骨缺损、骨髓炎的病例，采用游离皮瓣腓肠神经营养血管皮瓣和筋膜皮瓣及腓肠肌内、外侧头肌皮瓣转位等加外固定架结合的方法治疗。结果 除1例骨髓炎外，全部病例小腿创面均愈合。采用半环架与皮瓣结合治疗37例，其骨折愈合时间为6～14个月；力臂式外固定架的6例愈合时间为1年～2年8个月；组合式外固定的2例愈合时间为1年2个月。结论 半环架与皮瓣结合是治疗小腿大面积软组织缺损伴有骨折、骨缺损或骨髓炎的一种良好方法。     

Free vascularized osteocutaneous flap from scapula to the tibia

Summary Microvascular transfer of a free vascularized osteocutaneous flap from the scapula to the tibia is presented. The patient had a 10 cm tibial bone defect and also required overlying soft tissue reconstruction. A scapular osteocutaneous flap was successfully transferred to the proximal tibial defect. No complications were seen during an 18 month follow-up. Although the contralateral fibula is a popular choice for tibial reconstruction, if it is not available, the free vascularized scapular osteocutaneous flap may be an alternative choice of treatment.     

Masquelet技术结合小腿皮瓣治疗胫骨感染性骨缺损伴广泛软组织缺损的疗效分析

目的:探讨Masquelet技术结合小腿皮瓣治疗胫骨感染性骨缺损伴广泛软组织缺损的疗效。方法:回顾性分析2016年3月至2019年6月解放军联勤保障部队第九二〇医院骨科采用Masquelet技术结合小腿皮瓣治疗的23例胫骨感染性骨缺损伴有广泛胫前软组织缺损患者资料。其中男15例,女8例;年龄18~59岁（平均38.4岁...     

封闭负压引流联合腓肠肌肌皮瓣治疗胫前软组织缺损

目的探讨封闭负压引流(VSD)联合腓肠肌肌皮瓣治疗胫前软组织缺损的效果。方法对16例胫前中上2/3软组织缺损患者应用VSD联合腓肠肌肌皮瓣治疗。结果 16例均获随访,时间3个月～3年。1例患者行岛状肌皮瓣转移时,因皮瓣血运差改行肌瓣转移+植皮术,全部成活;1例患者出现内固定物排异反应,去除内固定物后伤口愈合。余14例患者皮瓣均成活,伤口一期愈合,对患肢膝、踝关节功能无明显影响。结论一期应用VSD覆盖创面,后行腓肠肌肌皮瓣转移治疗胫前不同平面软组织缺损,操作简单,效果满意。     

二处截骨骨搬移治疗胫骨大段骨缺损合并软组织缺损

目的 探讨二处截骨骨搬移治疗胫骨大段骨缺损合并软组织缺损的疗效及其加速骨和软组织愈合的可能性.方法 2009年5月至2011年5月共收治6例胫骨大段骨缺损合并软组织缺损患者,均为男性;年龄20～51岁,平均34.5岁.致伤原因:交通伤5例,机器压砸伤1例.均为Gustilo ⅢB型开放性骨折.小腿胫前软组织缺损面积为8cm ×4cm～24cm×11 cm,胫骨缺损长度为8～18cm.清创后采用半环槽外固定支架固定,胫骨上、下干骺端截骨骨搬移治疗骨缺损和软组织缺损.术后每侧截骨端骨搬移速度为1 mm/d,直至搬移骨折端对合,本组患者搬移所需时间为40～100 d,平均66.6 d. 结果 6例患者术后获10 ～ 36个月(平均16个月)随访.小腿软组织缺损愈合,骨缺损均获重建,4例患者双下肢等长,2例患肢肢体长度较健侧短缩1.5 cm.软组织愈合时间为60 ～ 180 d,平均103 d;骨愈合时间为12 ～31个月,平均19.3个月.所有患者牵拉结束后,未发现骨不连和骨痂愈合过快而无法继续牵拉成骨的现象,均不需要植骨. 结论 二处截骨骨搬移不但可有效治疗胫骨大段骨缺损合并软组织缺损,而且可加快骨搬移和软组织愈合的速度.     

骨滑移结合皮瓣修复小腿骨软组织缺损临床分析

<正>当前,随着经济生活的飞速发展,严重小腿骨与软组织损伤日益增多,大段骨及软组织缺损在治疗上十分棘手,游离植骨失败率高,吻合血管骨移植技术要求高。2001年至2008年     

骨外露组织缺损的显微外科修复

目的 报道游离皮瓣，带蒂岛状皮瓣移植复四肢复杂性组织缺损和骨外露的临床疗效。方法 应用显微外科方法施行皮瓣移植修复骨外露组织缺损２６例，其中游离皮瓣２０例，腓肠神经营养血和的岛状皮瓣６例。骨外露软组织缺损部位：足部４例，跟部５例，踝部４例，小腿胫，腓骨５例，手腕部８例。结果 ２６例皮瓣全部成活，仅有其中２例远端小部分坏死，经换药处理创面愈合。     

腓骨复合皮瓣Ⅰ期修复尺桡骨及软组织缺损

为完成尺桡骨及其软组织缺损的Ⅰ期修复,设计采用吻合血管的腓骨复合皮瓣并将腓骨折分为二的手术方法,已用于4例,都获满意效果,文中详细介绍了手术操作方法,并对本法的特点进行了阐述。     

股前外侧皮瓣联合股直肌肌腱瓣移植修复前臂软组织伴肌腱缺损

2005年6月至2009年3月,我们应用旋股外侧动脉降支肌皮穿支或肌间隙皮支为血供的股前外侧皮瓣,联合切取以旋股外侧动脉降支为蒂股直肌肌腱瓣游离移植修复7例前臂软组织伴肌腱缺损,术后疗效满意. 1.一般资料:本组7例,男6例,女1例;年龄18～42岁,平均26岁.均为外伤性前臂软组织缺损伴肌腱、血管缺损和部分骨质外露的创面.损伤原因:交通伤1例,机器绞伤2例,热压伤4例.左侧2例,右侧5例.前臂创面面积为8 cm×7cm～22cm×12 cm.其中背侧创面伴指伸肌腱缺损5例,掌侧创面伴指屈肌腱缺损2例,肌腱缺损长度为5～15 cm.1例急诊一期行修复术;2例因创面污染较重,清创术后二期行修复术;4例热压伤先行扩创、切痂后二期行修复术.     

股前外侧皮瓣联合股直肌肌腱瓣移植修复前臂软组织伴肌腱缺损

2005年6月至2009年3月,我们应用旋股外侧动脉降支肌皮穿支或肌间隙皮支为血供的股前外侧皮瓣,联合切取以旋股外侧动脉降支为蒂股直肌肌腱瓣游离移植修复7例前臂软组织伴肌腱缺损,术后疗效满意. 1.一般资料:本组7例,男6例,女1例;年龄18～42岁,平均26岁.均为外伤性前臂软组织缺损伴肌腱、血管缺损和部分骨质外露的创面.损伤原因:交通伤1例,机器绞伤2例,热压伤4例.左侧2例,右侧5例.前臂创面面积为8 cm×7cm～22cm×12 cm.其中背侧创面伴指伸肌腱缺损5例,掌侧创面伴指屈肌腱缺损2例,肌腱缺损长度为5～15 cm.1例急诊一期行修复术;2例因创面污染较重,清创术后二期行修复术;4例热压伤先行扩创、切痂后二期行修复术.     

股前外侧皮瓣联合股直肌肌腱瓣移植修复前臂软组织伴肌腱缺损

2005年6月至2009年3月,我们应用旋股外侧动脉降支肌皮穿支或肌间隙皮支为血供的股前外侧皮瓣,联合切取以旋股外侧动脉降支为蒂股直肌肌腱瓣游离移植修复7例前臂软组织伴肌腱缺损,术后疗效满意. 1.一般资料:本组7例,男6例,女1例;年龄18～42岁,平均26岁.均为外伤性前臂软组织缺损伴肌腱、血管缺损和部分骨质外露的创面.损伤原因:交通伤1例,机器绞伤2例,热压伤4例.左侧2例,右侧5例.前臂创面面积为8 cm×7cm～22cm×12 cm.其中背侧创面伴指伸肌腱缺损5例,掌侧创面伴指屈肌腱缺损2例,肌腱缺损长度为5～15 cm.1例急诊一期行修复术;2例因创面污染较重,清创术后二期行修复术;4例热压伤先行扩创、切痂后二期行修复术.     

Treatment of extensive bone and soft tissue defects of the lower limb by traction and free-flap transfer

Twenty patients with extensive bone and soft tissue defects and posttraumatic osteomyelitis were treated between 1983 and 1995. In all cases an external fixator was used for bone fixation. Bone defects were managed with the Ilizarov intercalary bone transport. Two types of traction were used: the Ilizarov type and a 'new' Ljubljana type. The results of treatment were compared between the two types of traction. In all cases delayed bony union was observed. Osteomyelitis never reactivated. All patients were satisfied with treatment. They were all independent except for one amputee. The Ljubljana traction method was found to have the following advantages: no discrepancy in leg length, no orthopaedic support was needed, the aesthetic outcome was better, the traction time was reduced and there was less soft tissue damage during bone traction.     

带蒂微型皮瓣修复指端软组织缺损

[目的]探讨6种类型的带蒂微型皮瓣在指端软组织缺损中的应用及临床效果.[方法]对148例208块创面临床应用6种类型的带蒂微型皮瓣进行修复,皮瓣面积5 cm×3.5 cm～1.5 cm×2 cm.[结果]转移皮瓣除1例切取失败,改行其它皮瓣修复,1例皮瓣蒂部受压,部分坏死,6例皮瓣在术后36～48 h明显肿胀,皮瓣远端出现表皮下积液、水疱等,给予拆除部分缝线,局部应用肝素等处理,3～4 d后皮瓣转红润,肿胀减轻,积液吸收,皮瓣成活,其余皮瓣未经特殊处理均顺利成活.随访6个月～5年,皮瓣外形好、耐磨,吻合神经的40例,皮瓣两点分辨觉在6～9 mm,没有吻合神经的皮瓣由于受区神经的长入也产生了保护性感觉功能.[结论]根据指别不同、创面大小、缺损部位、局部及邻指伤情、患者要求,选择合适的皮瓣,才能恢复较好的功能与外形.