小腿筋膜皮瓣修复局部软组织缺损的临床应用

目的:探讨小腿筋膜皮瓣转位修复小腿及足踝部软组织缺损的临床应用价值.方法:根据小腿及邻近部位软组织缺损的部位、大小、形状及小腿区域组织可利用情况,分别选择设计相应类型的小腿筋膜皮瓣修复49例缺损创面,采用小腿内侧筋膜皮瓣11例,其中1例带肌瓣;小腿外侧筋膜皮瓣32例,其中1例带肌瓣,2例远端去表皮真皮筋膜瓣;小腿后侧筋膜皮瓣6例.采用近端蒂顺行转移5例,远端蒂逆行转移44例; 3例经皮下隧道转移,46例经明道转移.创面4cm×6cm～9cm×17cm,切取小腿筋膜皮瓣5cm×7cm～11cm×19cm.结果:术后47例皮瓣Ⅰ期愈合;2例皮瓣远端部分坏死,经局部换药后Ⅱ期愈合.术后46例获得随访1～40个月,皮瓣外观平整,质地柔软,感觉不同程度恢复.结论:遵循小腿筋膜皮瓣血供的营养血管链设计应用相应类型的筋膜皮瓣,不仅利于皮瓣的切取和成活,而且修复后外观和感觉满意,有益于功能的恢复.

Classification and Clinical Application of Crural Fascia Flap

Objective：To expIore the classification and clinical effects of crural fascia flap. Methods： 49 cases with different types of crural fascia flaps were designed to repair the tissue defects according to the size,shape and location of defects in leg, the areas of defects and flaps were from 4cma × 6cm to 9cm × 17cm and from 5cm × 7cm to 11 cm× 19cm respectively, the medial, lateral and posterior flaps were used correspondingly in 11 cases （9cm ×2cm muscle flap affiliated to 1 case）, 32 cases （4cm × 3cm muscle flap affiliated to 1 case, 2 cases had distal dermis and fascial flap） and 6 eases, among them, 5 cases with subterminal pedicle, 44 cases with distal pedicte, 46 flaps were transferred to defects directly while 3 flaps were transferred through subdermal tunnel. Results：The surgery was successful, after the technique, all the flaps were survived completely, 47 cases healed primarily, and 2 cases with necrosis in the distal end of flaps healed later. 46 patients were followed up for 1 to 40 months ; all the flaps showed appropriate shape _ soft texture and satisfactory aesthesia. Conclusions ：To design and apply the corresponding fascia flap according to its blood supply is reliable for repairing leg tissue defects ; this method is good for the external and functional recovery of the leg as well.