小腿软组织缺损合并节段性骨缺损的显微外科修复

目的:探讨带长段骨骼的复合组织瓣Ⅰ期修复创伤性小腿复合组织缺损的临床修复效果.方法:12例小腿胫骨缺损合并软组织缺损的患者,应用以腓血管为蒂的腓骨皮瓣修复5例,以肩胛下血管为蒂的肩胛骨背阔肌骨肌(皮)复合组织瓣修复4例,以旋股外侧血管升支为蒂的髂骨阔筋膜张肌骨肌皮复合组织瓣3例.结果:1例肩胛骨背阔肌桥式交叉游离移植,术后患者因创伤后骨髓炎不愈合,坚决要求行截肢手术,其余组织瓣均存活,骨瓣愈合时间9-27月.结论:以上3种复合组织瓣均适合修复小腿的复合组织缺损且疗效满意.

Microsurgery Repair of Soft Tissue Defects of Lower Leg Combined with Segment Bone Defects

Objective: To appraise the outcome of repairing traumatic compound tissue defects of the lower leg with the composite tissue flaps of long segment bones in Stage Ⅰ.Methods: Twelve cases with the bone and soft tissue defects of lower leg were treated with composite tissue flaps respectively.Five cases of them were treated with fibula osteocutaneous flap,4 cases were treated with the osseous myocutaneous(muscle) flap of scapula and latissimus dorsi pedicled with subscapular vessels,and the other three were treated with the osseous myocutaneous flap of ilium and tensor fascia lata pedicled with the ascending branch of lateral femoral circumflex vessels.Results: Only one patient,who was repaired with free cross-bridge scapula latissimus dorsi flap,insisted to amputate his injured lower leg because of post-traumatic osteomyelitis.The other flaps survived completely.The time of bone healing was 9 to 27 months.Conclusion: The composite tissue flaps are suitable for repairing compound tissue defects of the lower leg and the curative effects were satisfactory.