封闭负压引流结合穿支蒂皮神经营养血管皮瓣治疗足踝部创面

目的探讨封闭负压引流技术结合3种小腿穿支蒂皮神经营养血管皮瓣治疗足踝部皮肤软组织缺损的临床效果。方法回顾性分析自2010-08—2013-06诊治的38例足踝部皮肤软组织缺损,创面彻底清创并应用封闭负压引流5~7 d后根据创面情况选择皮瓣修复,17例应用腓动脉穿支蒂腓肠神经营养血管皮瓣修复,8例应用外踝上穿支蒂腓浅神经营养血管皮瓣修复,13例应用胫后动脉穿支蒂隐神经营养血管皮瓣修复。结果术后皮瓣全部成活。随访5~12个月,无感染、骨坏死和慢性骨髓炎等并发症发生;皮瓣质地柔软,有弹性,供区愈合良好,足踝外形与功能恢复满意。结论应用封闭负压引流技术处理足踝部皮肤软组织缺损创面后,合理个体化选择小腿穿支蒂皮神经营养血管皮瓣修复,可减少感染机会及肉芽瘢痕,利于功能恢复。     

吻合皮神经的足底内侧皮瓣修复手掌皮肤缺损23例

目的：探讨吻合皮神经的足底内侧皮瓣修复手掌皮肤缺损的效果。方法对河北省唐山市丰南区医院2009年1月—2014年1月采用吻合皮神经的足底内侧皮瓣游离移植修复手掌皮肤缺损23例的临床资料进行回顾性分析。结果术后23例均获得随访,平均随访时间18个月。19例创面一期愈合,各指主动屈伸活动正常;3例经清创换药后创面二期愈合,各指主动屈伸功能轻度受限;1例皮瓣完全坏死经同侧带蒂腹股沟皮瓣修复后治愈,各指屈伸功能明显受限。优良率为95.7%。结论吻合皮神经的足底内侧皮瓣游离移植是修复手掌皮肤缺损的理想皮瓣,具有解剖位置恒定、皮瓣成活率高、术后手功能及外观功能恢复好的优点。     

带蒂阔筋膜张肌皮瓣与髂腹股沟皮瓣联合移植修复手部及前臂复杂皮肤缺损

目的：介绍带蒂阔筋膜张肌皮瓣与髂腹股沟皮瓣联合移植治疗手部及前臂复杂创面的手术方法和临床效果。方法：对7例手、腕及前臂部广泛皮肤套脱伤的患者,4例手部洞穿伤患者,2例全手逆行撕脱伤患者,急诊一期采用带蒂阔筋膜张肌皮瓣与髂腹股沟皮瓣联合移植修复皮肤缺损。髂腹股沟部供区创面直接闭合,大腿部供区创面取全厚层皮片植皮覆盖。术后半个月拆线,并进行皮瓣夹蒂训练,术后3周根据皮瓣夹蒂训练情况酌情断蒂,断蒂时将皮瓣内的腹壁浅神经、股前外侧皮神经分别于受区皮神经吻合。断蒂术后1~2个月分期皮瓣修整。结果：13例皮瓣全部存活,受区、供区伤口I期愈合。术后随访2~6个月,皮瓣柔软,质地良好,皮瓣温痛感觉良好,外形无臃肿,无坏死及破溃;总优良率为84.6%。结论：带蒂阔筋膜张肌皮瓣与髂腹股沟皮瓣联合移植治疗手部及前臂复杂创面,相对其他带蒂联合皮瓣移植患者手部体位较舒适,手术操作简单,安全性高,易于推广。     

Distally based perforator flaps for reconstruction of post-traumatic defects of the lower leg and foot. A review of the anatomy and clinical outcomes

Study aims

To report the surgical anatomy of the perforator arteries at the lower leg, analyse clinical outcomes in previous studies, and forward methodological recommendations for future studies of post-traumatic perforator flap reconstructions.

Methods

A study sample of 640 human patients drawn from 24 clinical reports was included for review. The sample comprised of four subsets: sural flap reconstructions (n = 257), saphenous flaps (n = 122), supramalleolar flaps (n = 92), and propeller flaps (n = 169).

Results

Statistical analysis of samples from anatomical studies documents significant differences in the perforator distribution from the tibial and peroneal artery; peroneal perforator arteries are randomly organised whereas tibial artery perforators are clustered at three definite levels. The failure rates in clinical studies ranged from 0% to 6%, being lowest for supramalleolar flap reconstructions and highest for saphenous flaps; however, differences between the four subsets were not statistically significant at the 95% confidence level. Due to methodological flaws, outcome comparisons in the actual study sample should be interpreted cautiously; in most clinical studies both risk variables and outcome indicators are poorly defined. The outcome of Dynamic Infrared Thermography imaging of post-transposition changes of flap perfusion is reported.

Summary

Fasciocutaneous perforator flaps seem to have high survival rates and represent a feasible approach to post-traumatic reconstructions, especially in low-resource settings. A template for data gathering is recommended for higher accuracy in future comparative studies, and for scientific analysis of success and risk factors. New imaging techniques indicate a promising potential of micro-circular angiogenesis during the first two weeks after flap transpose.     

封闭负压引流技术在开放骨折合并软组织缺损治疗中的作用

目的探讨封闭负压引流技术(VSD)在治疗开放骨折合并软组织缺损中的作用。方法应用VSD及内固定或外固定支架结合植皮或邻近皮瓣治疗25例开放骨折合并软组织缺损患者。结果患者均获随访,时间4~18个月。16例患者VSD术后5~7 d解除负压,经植皮治疗后创面均愈合;7例较严重开放骨折合并软组织缺损患者经2次VSD治疗后,给予植皮+邻近皮瓣转移覆盖创面后创面均愈合;2例严重开放骨折合并软组织缺损患者经3次VSD治疗后,行植皮+邻近皮瓣转移覆盖创面治疗后均获得愈合。结论 VSD能刺激肉芽组织生长,控制创面炎症,只需结合简单易行的植皮或邻近皮瓣应用即可理想地修复组织缺损创面。     

第一跖背动脉筋膜蒂逆行皮瓣修复拇趾趾端缺损

目的探讨第一跖背动脉筋膜蒂逆行皮瓣修复拇趾趾端缺损临床效果。方法设计、切取第一跖背动脉筋膜蒂逆行皮瓣修复7例拇趾趾端缺损患者,缺损面积2 cm×2.5 cm~3 cm×3.5 cm,皮瓣大小2.5 cm×3cm~3.5 cm×4.5 cm。结果 7例均获随访,时间4~20个月,皮瓣均完全成活,患者拇趾趾端创面均获得良好覆盖,皮瓣质地、弹性、色泽均正常,耐磨、耐压。无溃疡发生。蒂部不臃肿。结论第一跖背动脉筋膜蒂逆行皮瓣修复拇趾趾端缺损手术相对简单、安全,皮瓣厚度适中、弹性好、色泽好、耐磨、耐压,可防止溃疡,临床效果满意。     

Consecutive flap transfer for repairing massive soft tissue defects in the opisthenar with improved donor site closure

Objective：To explore a surgical model of utilizing consecutive free scapular flap and adjacent pedicled flap transfer for repairing massive soft tissue defects on the dorsum of the hand while minimizing the donor site morbidity.Methods：Six patients with massive soft tissue injuries on the opisthenar and forearm were treated with free scapular flaps.Afterwards,a pedicled flap adjacent to the donor site was transferred to cover the donor site defect by direct closure.Results：All six free scapular flaps survived without signs of infection.Three adjacent pedicled flaps presented minor signs of insufficient blood flow on the distal apex,which resolved after six weeks with only conservative therapy.All the incisions healed without other complications.At six-month follow-up,the patients regained full shoulder function.Conclusion：With the assistance of an adjacent pedicled flap,the scapular flap is a highly applicable approach in repairing massive soft tissue defects in the opisthenar.It can achieve positive outcomes in both reconstructive and aesthetic aspects.     

Combined index finger pollicization with an anterolateral thigh flap for thumb reconstruction

A severe crush injury to the hand is devastating to patients. Under conditions in which the crush force is too great, the digits are not viable candidates for replantation. We present two cases in which the patients suffered from loss of the thumb ray at the first carpometacarpal joint and skin defect at the radial side. The tendons, radial nerve and metacarpal bone of the index finger were injured, and the second metacarpal head was retained. There was a comminuted fracture of the trapezium in both patients. The treatment protocols consisted of the index finger pollicization and the free anterolateral thigh flap transfer. The procedure was performed in a single operation. The new thumb is able to provide a stable post for pinch and grip after six months follow-up. Both patients were satisfied with the function and appearance of the reconstructed thumb.     

远端筋膜蒂第一跖背动脉皮瓣修复躅趾皮肤缺损

目的探讨远端筋膜蒂第一跖背动脉皮瓣修复蹰趾皮肤缺损的临床效果。方法回顾性分析2008年10月～2013年10月采用远端筋膜蒂第一跖背动脉皮瓣修复躅趾皮肤缺损患者9例,供区行中厚皮片移植。结果9例患者均获得随访,随访时间平均6（3～12）个月。皮瓣全部成活,皮瓣颜色、质地、厚薄与受区皮肤相近。1例皮瓣少许皮肤坏死,经换药3周后Ⅱ期愈合。供区植皮均Ⅰ期愈合。两点辨别觉为6～13mm,患者行走正常,皮瓣及供区植皮处皮肤无破溃。患者对外观、功能满意。结论相较于传统第一跖背动脉皮瓣,远端筋膜蒂第一跖背动脉皮瓣血管蒂长,转移覆盖范围增大,皮瓣血供更有保障,供区影响小,术后外形良好,是修复躅趾皮肤缺损的一种较好的方法。     

拇指尺背侧岛状皮瓣修复拇指深度创面的临床应用

目的 了解拇指尺背侧岛状皮瓣修复拇指深度创面的效果 . 方法 2007年5 月-201 3年12月,笔者单位应用拇指尺背侧岛状皮瓣共修复22例患者拇指Ⅳ度损伤创面,创面面积为2.0cm×1.5cm～4.0cm×2.5cm,皮瓣切取面积为2.1cm×1.6cm～4.1cm×2.6cm,供瓣区均于同侧上臂内侧切取全厚皮片移植修复 . 结果 术后皮瓣全部成活,血运良好,拇指创面愈合良好,供瓣区移植皮片成活 . 术后随访6个月～1年,患者皮瓣质地、色泽、外形良好,患指功能恢复良好.结论 拇指尺背侧岛状皮瓣具有手术操作简单、术后成活率高、外形不臃肿等优点,是修复拇指深度创面的较佳选择.