跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损

目的 探讨跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损的临床效果.方法 对髂骨皮瓣进行解剖学研究,提出采用旋髂深动脉、旋髂浅动脉串联供血的跨供区髂骨皮瓣新术式.模拟该术式,采用墨汁灌注的方法对跨供区髂骨皮瓣的供血面积及血流量进行测量.采用此术式一期修复四肢大面积骨与软组织缺损患者32例,男20例,女12例;年龄17～68岁,平均36岁.采用激光多普勒血流测定仪对跨供区髂骨皮瓣的血流量进行测定.结果 模拟术式的新鲜尸体墨汁灌注墨染结果:髂骨瓣,从距髂前上棘(15.8±3.2)cm处可见墨染情况;皮瓣,以髂前上棘为中心上及(8.6±2.4)cm、下达(5.4±2.6)cm、向内至(5.8±2.6)cm,向外至(24.6±5.8)cm均可见墨染情况.血流量测定结果显示:皮瓣周缘的血流量随时间的延长而逐渐增加,在灌注后第3天增加变缓,进入相对平台期.临床应用的32例患者皮瓣全部成活,外形及功能恢复良好.除1例患者经二次手术骨折经22个月愈合外,其余31例患者骨愈合时间为9～19个月,平均12个月.结论 跨供区髂骨皮瓣血供充分,可一期修复四肢大面积骨与软组织缺损.     

跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损

Objective To study the clinical effect of iliac flap straddled donor area to primary repair large defect of bone and soft tissue. Methods Through the anatomical study about iliac flap, the new oper-ation method about iliac flap was designed, which straddled donor area and used one blood vessel stem (deep iliae circumflex artery) and two branch blood vessel(deep iliac circumflex artery and superficial iliac circum-flex artery compounding in series) for blood supply. Blood supply area of the analogical operation was stud-ied by irrigating fresh cadaver with Indian ink. Thirty-two patients with large defect of bone and soft tissue (20 males, 12 females, 17-68 years old, average 36 years old) were repaired by this method, and the hemo-dynamics was studied by laser Doppler flowmetry. Results It was feasible to connect superficial iliac cir-cumflex artery with the branch of deep iliac circumflex artery. Indian ink irrigating fresh cadaver simulate operation showed that area scope dyed by Indian ink: in ilium, Indian ink was found in the bone which was (15.8±3.2) cm away from anterior superior iliac spine. In skin flap, Indian ink was found (8.6±2.4) cm superi-or, (5.4±2.6) cm inferior, (5.8±2.6) cm internal and (24.6±5.8) cm external from the anterior superior iliac spine. Laser Doppler flowmetry showed that the peripheral blood flow of skin flap increased as time passed, the increase speed began to tardy at the third day, then ingress the platform stage. Thirty-two cases were all succeed with functional rehabilitation and perfect shape. Thirty-one cases got completely bone healing; bone healing time ranged from 9 to 19 months, with an average of 12 months. One case turned to chronic os-teomyelitis, and had to suffer operation again, the bone healing time was 22 months. Conclusion As the ili-ae flap straddled donor area has sufficient blood supply, it can repair large defect of bone and soft tissue in one stage.     

跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损

Objective To study the clinical effect of iliac flap straddled donor area to primary repair large defect of bone and soft tissue. Methods Through the anatomical study about iliac flap, the new oper-ation method about iliac flap was designed, which straddled donor area and used one blood vessel stem (deep iliae circumflex artery) and two branch blood vessel(deep iliac circumflex artery and superficial iliac circum-flex artery compounding in series) for blood supply. Blood supply area of the analogical operation was stud-ied by irrigating fresh cadaver with Indian ink. Thirty-two patients with large defect of bone and soft tissue (20 males, 12 females, 17-68 years old, average 36 years old) were repaired by this method, and the hemo-dynamics was studied by laser Doppler flowmetry. Results It was feasible to connect superficial iliac cir-cumflex artery with the branch of deep iliac circumflex artery. Indian ink irrigating fresh cadaver simulate operation showed that area scope dyed by Indian ink: in ilium, Indian ink was found in the bone which was (15.8±3.2) cm away from anterior superior iliac spine. In skin flap, Indian ink was found (8.6±2.4) cm superi-or, (5.4±2.6) cm inferior, (5.8±2.6) cm internal and (24.6±5.8) cm external from the anterior superior iliac spine. Laser Doppler flowmetry showed that the peripheral blood flow of skin flap increased as time passed, the increase speed began to tardy at the third day, then ingress the platform stage. Thirty-two cases were all succeed with functional rehabilitation and perfect shape. Thirty-one cases got completely bone healing; bone healing time ranged from 9 to 19 months, with an average of 12 months. One case turned to chronic os-teomyelitis, and had to suffer operation again, the bone healing time was 22 months. Conclusion As the ili-ae flap straddled donor area has sufficient blood supply, it can repair large defect of bone and soft tissue in one stage.     

跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损

Objective To study the clinical effect of iliac flap straddled donor area to primary repair large defect of bone and soft tissue. Methods Through the anatomical study about iliac flap, the new oper-ation method about iliac flap was designed, which straddled donor area and used one blood vessel stem (deep iliae circumflex artery) and two branch blood vessel(deep iliac circumflex artery and superficial iliac circum-flex artery compounding in series) for blood supply. Blood supply area of the analogical operation was stud-ied by irrigating fresh cadaver with Indian ink. Thirty-two patients with large defect of bone and soft tissue (20 males, 12 females, 17-68 years old, average 36 years old) were repaired by this method, and the hemo-dynamics was studied by laser Doppler flowmetry. Results It was feasible to connect superficial iliac cir-cumflex artery with the branch of deep iliac circumflex artery. Indian ink irrigating fresh cadaver simulate operation showed that area scope dyed by Indian ink: in ilium, Indian ink was found in the bone which was (15.8±3.2) cm away from anterior superior iliac spine. In skin flap, Indian ink was found (8.6±2.4) cm superi-or, (5.4±2.6) cm inferior, (5.8±2.6) cm internal and (24.6±5.8) cm external from the anterior superior iliac spine. Laser Doppler flowmetry showed that the peripheral blood flow of skin flap increased as time passed, the increase speed began to tardy at the third day, then ingress the platform stage. Thirty-two cases were all succeed with functional rehabilitation and perfect shape. Thirty-one cases got completely bone healing; bone healing time ranged from 9 to 19 months, with an average of 12 months. One case turned to chronic os-teomyelitis, and had to suffer operation again, the bone healing time was 22 months. Conclusion As the ili-ae flap straddled donor area has sufficient blood supply, it can repair large defect of bone and soft tissue in one stage.     

跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损

Objective To study the clinical effect of iliac flap straddled donor area to primary repair large defect of bone and soft tissue. Methods Through the anatomical study about iliac flap, the new oper-ation method about iliac flap was designed, which straddled donor area and used one blood vessel stem (deep iliae circumflex artery) and two branch blood vessel(deep iliac circumflex artery and superficial iliac circum-flex artery compounding in series) for blood supply. Blood supply area of the analogical operation was stud-ied by irrigating fresh cadaver with Indian ink. Thirty-two patients with large defect of bone and soft tissue (20 males, 12 females, 17-68 years old, average 36 years old) were repaired by this method, and the hemo-dynamics was studied by laser Doppler flowmetry. Results It was feasible to connect superficial iliac cir-cumflex artery with the branch of deep iliac circumflex artery. Indian ink irrigating fresh cadaver simulate operation showed that area scope dyed by Indian ink: in ilium, Indian ink was found in the bone which was (15.8±3.2) cm away from anterior superior iliac spine. In skin flap, Indian ink was found (8.6±2.4) cm superi-or, (5.4±2.6) cm inferior, (5.8±2.6) cm internal and (24.6±5.8) cm external from the anterior superior iliac spine. Laser Doppler flowmetry showed that the peripheral blood flow of skin flap increased as time passed, the increase speed began to tardy at the third day, then ingress the platform stage. Thirty-two cases were all succeed with functional rehabilitation and perfect shape. Thirty-one cases got completely bone healing; bone healing time ranged from 9 to 19 months, with an average of 12 months. One case turned to chronic os-teomyelitis, and had to suffer operation again, the bone healing time was 22 months. Conclusion As the ili-ae flap straddled donor area has sufficient blood supply, it can repair large defect of bone and soft tissue in one stage.     

跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损

Objective To study the clinical effect of iliac flap straddled donor area to primary repair large defect of bone and soft tissue. Methods Through the anatomical study about iliac flap, the new oper-ation method about iliac flap was designed, which straddled donor area and used one blood vessel stem (deep iliae circumflex artery) and two branch blood vessel(deep iliac circumflex artery and superficial iliac circum-flex artery compounding in series) for blood supply. Blood supply area of the analogical operation was stud-ied by irrigating fresh cadaver with Indian ink. Thirty-two patients with large defect of bone and soft tissue (20 males, 12 females, 17-68 years old, average 36 years old) were repaired by this method, and the hemo-dynamics was studied by laser Doppler flowmetry. Results It was feasible to connect superficial iliac cir-cumflex artery with the branch of deep iliac circumflex artery. Indian ink irrigating fresh cadaver simulate operation showed that area scope dyed by Indian ink: in ilium, Indian ink was found in the bone which was (15.8±3.2) cm away from anterior superior iliac spine. In skin flap, Indian ink was found (8.6±2.4) cm superi-or, (5.4±2.6) cm inferior, (5.8±2.6) cm internal and (24.6±5.8) cm external from the anterior superior iliac spine. Laser Doppler flowmetry showed that the peripheral blood flow of skin flap increased as time passed, the increase speed began to tardy at the third day, then ingress the platform stage. Thirty-two cases were all succeed with functional rehabilitation and perfect shape. Thirty-one cases got completely bone healing; bone healing time ranged from 9 to 19 months, with an average of 12 months. One case turned to chronic os-teomyelitis, and had to suffer operation again, the bone healing time was 22 months. Conclusion As the ili-ae flap straddled donor area has sufficient blood supply, it can repair large defect of bone and soft tissue in one stage.     

跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损

Objective To study the clinical effect of iliac flap straddled donor area to primary repair large defect of bone and soft tissue. Methods Through the anatomical study about iliac flap, the new oper-ation method about iliac flap was designed, which straddled donor area and used one blood vessel stem (deep iliae circumflex artery) and two branch blood vessel(deep iliac circumflex artery and superficial iliac circum-flex artery compounding in series) for blood supply. Blood supply area of the analogical operation was stud-ied by irrigating fresh cadaver with Indian ink. Thirty-two patients with large defect of bone and soft tissue (20 males, 12 females, 17-68 years old, average 36 years old) were repaired by this method, and the hemo-dynamics was studied by laser Doppler flowmetry. Results It was feasible to connect superficial iliac cir-cumflex artery with the branch of deep iliac circumflex artery. Indian ink irrigating fresh cadaver simulate operation showed that area scope dyed by Indian ink: in ilium, Indian ink was found in the bone which was (15.8±3.2) cm away from anterior superior iliac spine. In skin flap, Indian ink was found (8.6±2.4) cm superi-or, (5.4±2.6) cm inferior, (5.8±2.6) cm internal and (24.6±5.8) cm external from the anterior superior iliac spine. Laser Doppler flowmetry showed that the peripheral blood flow of skin flap increased as time passed, the increase speed began to tardy at the third day, then ingress the platform stage. Thirty-two cases were all succeed with functional rehabilitation and perfect shape. Thirty-one cases got completely bone healing; bone healing time ranged from 9 to 19 months, with an average of 12 months. One case turned to chronic os-teomyelitis, and had to suffer operation again, the bone healing time was 22 months. Conclusion As the ili-ae flap straddled donor area has sufficient blood supply, it can repair large defect of bone and soft tissue in one stage.     

跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损

Objective To study the clinical effect of iliac flap straddled donor area to primary repair large defect of bone and soft tissue. Methods Through the anatomical study about iliac flap, the new oper-ation method about iliac flap was designed, which straddled donor area and used one blood vessel stem (deep iliae circumflex artery) and two branch blood vessel(deep iliac circumflex artery and superficial iliac circum-flex artery compounding in series) for blood supply. Blood supply area of the analogical operation was stud-ied by irrigating fresh cadaver with Indian ink. Thirty-two patients with large defect of bone and soft tissue (20 males, 12 females, 17-68 years old, average 36 years old) were repaired by this method, and the hemo-dynamics was studied by laser Doppler flowmetry. Results It was feasible to connect superficial iliac cir-cumflex artery with the branch of deep iliac circumflex artery. Indian ink irrigating fresh cadaver simulate operation showed that area scope dyed by Indian ink: in ilium, Indian ink was found in the bone which was (15.8±3.2) cm away from anterior superior iliac spine. In skin flap, Indian ink was found (8.6±2.4) cm superi-or, (5.4±2.6) cm inferior, (5.8±2.6) cm internal and (24.6±5.8) cm external from the anterior superior iliac spine. Laser Doppler flowmetry showed that the peripheral blood flow of skin flap increased as time passed, the increase speed began to tardy at the third day, then ingress the platform stage. Thirty-two cases were all succeed with functional rehabilitation and perfect shape. Thirty-one cases got completely bone healing; bone healing time ranged from 9 to 19 months, with an average of 12 months. One case turned to chronic os-teomyelitis, and had to suffer operation again, the bone healing time was 22 months. Conclusion As the ili-ae flap straddled donor area has sufficient blood supply, it can repair large defect of bone and soft tissue in one stage.     

跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损

Objective To study the clinical effect of iliac flap straddled donor area to primary repair large defect of bone and soft tissue. Methods Through the anatomical study about iliac flap, the new oper-ation method about iliac flap was designed, which straddled donor area and used one blood vessel stem (deep iliae circumflex artery) and two branch blood vessel(deep iliac circumflex artery and superficial iliac circum-flex artery compounding in series) for blood supply. Blood supply area of the analogical operation was stud-ied by irrigating fresh cadaver with Indian ink. Thirty-two patients with large defect of bone and soft tissue (20 males, 12 females, 17-68 years old, average 36 years old) were repaired by this method, and the hemo-dynamics was studied by laser Doppler flowmetry. Results It was feasible to connect superficial iliac cir-cumflex artery with the branch of deep iliac circumflex artery. Indian ink irrigating fresh cadaver simulate operation showed that area scope dyed by Indian ink: in ilium, Indian ink was found in the bone which was (15.8±3.2) cm away from anterior superior iliac spine. In skin flap, Indian ink was found (8.6±2.4) cm superi-or, (5.4±2.6) cm inferior, (5.8±2.6) cm internal and (24.6±5.8) cm external from the anterior superior iliac spine. Laser Doppler flowmetry showed that the peripheral blood flow of skin flap increased as time passed, the increase speed began to tardy at the third day, then ingress the platform stage. Thirty-two cases were all succeed with functional rehabilitation and perfect shape. Thirty-one cases got completely bone healing; bone healing time ranged from 9 to 19 months, with an average of 12 months. One case turned to chronic os-teomyelitis, and had to suffer operation again, the bone healing time was 22 months. Conclusion As the ili-ae flap straddled donor area has sufficient blood supply, it can repair large defect of bone and soft tissue in one stage.     

跨供区髂骨皮瓣一期修复肢体大面积骨与软组织缺损

Objective To study the clinical effect of iliac flap straddled donor area to primary repair large defect of bone and soft tissue. Methods Through the anatomical study about iliac flap, the new oper-ation method about iliac flap was designed, which straddled donor area and used one blood vessel stem (deep iliae circumflex artery) and two branch blood vessel(deep iliac circumflex artery and superficial iliac circum-flex artery compounding in series) for blood supply. Blood supply area of the analogical operation was stud-ied by irrigating fresh cadaver with Indian ink. Thirty-two patients with large defect of bone and soft tissue (20 males, 12 females, 17-68 years old, average 36 years old) were repaired by this method, and the hemo-dynamics was studied by laser Doppler flowmetry. Results It was feasible to connect superficial iliac cir-cumflex artery with the branch of deep iliac circumflex artery. Indian ink irrigating fresh cadaver simulate operation showed that area scope dyed by Indian ink: in ilium, Indian ink was found in the bone which was (15.8±3.2) cm away from anterior superior iliac spine. In skin flap, Indian ink was found (8.6±2.4) cm superi-or, (5.4±2.6) cm inferior, (5.8±2.6) cm internal and (24.6±5.8) cm external from the anterior superior iliac spine. Laser Doppler flowmetry showed that the peripheral blood flow of skin flap increased as time passed, the increase speed began to tardy at the third day, then ingress the platform stage. Thirty-two cases were all succeed with functional rehabilitation and perfect shape. Thirty-one cases got completely bone healing; bone healing time ranged from 9 to 19 months, with an average of 12 months. One case turned to chronic os-teomyelitis, and had to suffer operation again, the bone healing time was 22 months. Conclusion As the ili-ae flap straddled donor area has sufficient blood supply, it can repair large defect of bone and soft tissue in one stage.