桥式交叉吻合皮瓣游离移植修复下肢大面积皮肤缺损

目的：探讨桥式交叉吻合皮瓣游离移植修复小腿及足部大面积皮肤缺损的手术适应证、技巧、方法及注意事项，以提高手术成功率。方法：对我科2007—04—2012—12所做的桥式交叉吻合游离皮瓣52例进行回顾性总结。所有患者均为一侧小腿或足部大面积皮肤缺损，创面清创后解剖游离对侧小腿胫后动、静脉为血管蒂，切取胸脐皮瓣或股前外侧皮瓣游离移植覆盖创面，双小腿在合适位置以组合式外固定架固定，皮瓣血管蒂与对侧胫后动静脉吻合，蒂部制成皮管，术后25～30d断蒂。结果：除一例皮瓣远端约1／3坏死外，余皮瓣全部顺利成活。质地柔软，外形良好，患肢功能满意。结论：对伤肢无可供血管蒂、常规局部皮瓣转移或交腿皮瓣无法覆盖的创面，桥式交叉吻合游离皮瓣转移修复不失为一种较好的修复方法。

Bridge,cross anastomosis of free flap graft to repair large - area skin defects of lower limbs

Objective：To discuss the operation indication, technique, method and relevant matter of the bridge cross anastomosis of free flap graft for large - area skin defect of !egs and feet to improve the success rate of opera- tion. Methods：A total of 52 patients underwent surgery from April 2007 to December 2012 were retrospectively summarized. All patients had large - area skin defects on one - side lower legs or feet. After wound debridement, the posterior tibial artery and vein of the opposite lower leg were dissected as vascular pedicle, and the thoracic um- bilical flap or the anterolateral free flap of the thigh were used to cover the wound. Both legs were fixed in place with combined - type external fixation frames, the vascular pedicles of free flaps were anastomosed with the opposite posterior tibial artery and vein, and the pedicle skin tubes were made and amputated 25 - 30 days after surgery. Results：All the flaps survived except one case with about one -third distal flap necrosis. The flaps had soft tex- ture, perfect appearance and satisfactory function. Conclusion： For the injured limbs impossible to be repaired with local vascular pedicle, routine local transfer of skin flap or cross leg skin flap, the bridge cross anastomosis of free flap graft may be an ideal surgical treatment .