小腿肌肉、肌间血管全部坏死并感染的肢体保留术式介绍

目的 探索全部去除小腿感染坏死肌肉和肌间血管，仅保留小腿皮肤筋膜、胫骨时，踝足延时成活的影响因素以及重建动脉循环对避免足坏死或缺血挛缩的作用。方法 对1例左小腿肌肉及肌间血管坏死并感染患者，在全部去除小腿肌肉、骨间膜、肌间血管和腓骨，仅以小腿皮肤筋膜包绕胫骨连接踝足，术中发现踝关节水平下胫后动脉内无血栓，并有微量暗红色血液外溢，一期经踝行健侧胫后动脉转位与患肢胫后动脉吻合，二期进行健侧胫后动脉长段分离，向患侧转位，完成患肢胭动脉直接向足和小腿的动脉供血。结果 术后7个月患足基本恢复了触痛觉，患肢皮温、皮色正常，足部肌肉及关节无挛缩畸形，可平稳站立，可持拐行走。结论 当小腿肌肉、肌间血管因坏死感染被全部去除时，小腿皮肤、深浅筋膜组织与胫骨内血供系统之间形成的网状侧支循环，能为患足提供微量供血，延缓足的坏死或缺血挛缩；对此类患者进行动脉血运重建，可使伤肢获得良好的成活效果。

Introduction of limb reservation operation for an infected and all muscles and intermuscular vessels necrosed leg

Objective to study the factors of delaying survival of the ankle and foot which were linked with leg only by skin, fascia and tibia after all the infected and inactivated muscles and intermuscular vessels had been removed, and to study the effect of artery blood supply reconstruction to avoid the necrosis and ischemia contracture of the foot. Methods The leg was linked with ankle and foot by the tibia which was covered only by skin and fascia after all the muscles, interosseous membrance, intermuscular vessels and fibula had been removed. And then the artery blood supply for the injured limb was reconstructed by stages. Results The sense of haphalgesia, with normal temperature and color, recovered in the injured limb 7 months after operation, no contracture and deformity happened in the food muscles and joint, and the patient may smooth stand and walk with a stick freely. Conclusion The necrosis and ischemia contracture of foot was delayed by reticular collateral circulation among skin, deep and superficial fascia and tibia of the injured limb, although the blood supply was very little after all the muscles and intermuscular vessels had been removed because of infection and necrosis. Finally the injured limb was reserved successfully by artery blood supply reconstruction. The clinical effect was satisfactory.