小腿外侧腓骨皮瓣交腿修复合并血管损伤的大段胫骨骨感染及缺损

 目的 探讨小腿外侧腓骨皮瓣交腿修复合并血管损伤、大面积皮肤软组织缺损的大段胫骨骨感染及缺损的疗效。方法 回顾性分析2004 年9 月至2008 年9月治疗8 例合并血管损伤的大段胫骨骨感染及缺损患者资料, 男6 例, 女2 例;年龄19~55 岁, 平均36 岁;病史2 周至3 个月, 平均2 个月;胫骨缺损长度8~20 cm, 平均13 cm;皮肤缺损面积10 cm x 7 cm~22 cm x 12 cm。彻底清创, 根据皮肤软组织缺损面积及胫骨缺损长度在健侧小腿设计外侧腓骨皮瓣的切取范围、腓骨切取长度、切取位置。切取皮瓣及腓骨, 将双下肢交叉于蒂部松弛位置, 外固定支架固定, 腓骨修复胫骨骨缺损, 外固定支架一期重建胫骨稳定性, 皮瓣覆盖创面修复皮肤软组织缺损。术后4~6 周, 二次手术断蒂。结果 8 例患者全部获得随访, 随访时间6~36 个月, 平均24 个月。术后8 例移植组织全部成活, 无一例发生感染及骨髓炎, 皮瓣均在术后2 周顺利愈合;骨折愈合时间6~15 个月, 平均11 个月;移植皮瓣外形良好;患者基本恢复负重行走功能。末次随访时, 根据Edwards 胫骨骨折评定标准, 优4 例, 良2 例, 差2 例。结论 小腿外侧腓骨皮瓣交腿修复合并血管损伤、大面积皮肤软组织缺损的大段胫骨骨感染及缺损具有手术操作相对简单、成功率高、疗效好等优点, 可恢复患者下肢行走功能。

Use of cross-leg fibula flap for difficult reconstruction of extensive injuries in the lower extremities

Objective To study clinical outcomes of cross-leg fibula flap for difficult reconstruction of an extensive injury in the lower extremity, which included large soft-tissue defects and long infected bone and tibia defects combined with vascular injury. Methods From September 2004 to September 2008, 8 cases with an extensive injury in the lower extremity, which included large soft-tissue defects and long infected bone and tibia defects with vascular injury, were retrospectively analyzed, including 6 males and 2 females with an average age of 36 years (range, 19-55 years). The course of disease ranged from 2 weeks to 3 months (average, 2 months). The bone defect length ranged from 8 to 20 cm (average, 13 cm), and the skin defect area varied from 10 cm x 7 cm to 22 cm x 12 cm. After thorough debridement, cross-leg fibula flap was used to repair the tibial defect and concomitant soft tissue defect. The pedicles were divided at 4-6 weeks after the initial surgery. The important technical considerations were outlined. Results All 8 patients were followed up for 6 to 36 months (average, 24 months). The flaps survived in all 8 patients, and no infection and osteomyelitis happened. The flap transplantations healed at two weeks after operation with good shape. The fractures healed in all of patients with an average period of 11 months (range, 6-15 months). All of patients recovered to walk without aid. According to Edwards classification of tibial fractures, 4 cases were classified as good, 2 as acceptable, and 2 as poor. Conclusion The cross-leg fibula flap is relatively simple, liable for the treatment of an extensive injury in the lower extremity.