利用截肢肢体游离组织瓣移植修复残端创面

目的探讨利用截肢肢体游离组织瓣移植修复残端创面的疗效。方法 2010年8月-2011年6月,收治下肢严重毁损伤患者5例。男4例,女1例;年龄3岁8个月～43岁。交通事故伤3例,机器绞轧伤2例。受伤至入院时间2～9 h。合并单侧骨盆毁损、髋关节外伤性截肢1例;股骨近端开放性粉碎性骨折、大腿皮肤软组织完整1例;合并大腿皮肤软组织毁损、膝关节以远小腿皮肤软组织完整3例。急诊截肢后残端创面范围为20 cm×10 cm～20 cm×20 cm,2例于截肢肢体切取股前外侧皮瓣、3例切取小腿内侧皮瓣,皮瓣切取范围为15 cm×10 cm～25 cm×20 cm,吻合血管蒂后一期修复残端创面。结果术后7～10 d,截肢创缘均出现不同程度皮肤坏死,再次行清创术切除坏死组织,采用换药(3例)或持续负压封闭引流(2例)治疗1～2个月后游离组织瓣均顺利成活。患者获随访1～3个月。患肢残端无窦道、溃疡形成,残端外形饱满,皮瓣质地良好。结论截肢肢体游离组织瓣移植修复毁损伤截肢残端创面可获满意疗效。

Free tissue transplantation from amputated limbs for covering raw surface of stumps

Objective To investigate and evaluate the effectiveness of covering amputated raw surface with free tissue transplantation from damaged limbs.Methods Between August 2010 and June 2011,5 cases of severe injury of lower extremities were treated,including 4 males and 1 female with an age range of 3 years and 8 months to 43 years.Of them,3 cases suffered from traffic accident injury and 2 had machine injury.The disease duration was 2-9 hours.Among the 5 cases,1 suffered from half pelvis destruction and traumatic amputation of hi p joint,1 from comminuted open fracture of proximal femur,and another 3 from thigh destruction with survival soft tissue of legs.All cases were treated with emergency operation of amputation. The raw surface of the residual stumps was 20 cm×10 cm to 20 cm×20 cm in size.Two lateral anterior thigh flaps and 3 posterior tibial artery flaps were harvested from the damaged limbs.The flap size ranged from 15 cm×10 cm to 25 cm×20 cm.The wounds were repaired with free tissue transplantation.Results Five transplanted tissue flaps were survival.Skin necrosis occurred in the wound edge at 7-10 days postoperatively and was cured after excision of necrotic tissue,dressing change or vacuumed drainage for 1-2 months.All wounds healed and the patients were followed up 1-3 months.No sinus tract or ulceration was observed. The appearance of stumps was satisfactory.Conclusion The effectiveness of repairing amputated raw surface with free tissue transplantation from amputated limbs is satisfactory.It is an effective procedure to repair the raw surface of amputated stumps.