胸脐皮瓣移植修复下肢大面积软组织缺损并骨外露15例

【摘要】〓目的〓介绍胸脐皮瓣游离移植修复小腿软组织缺损的方法和体会。方法〓本组共15例患者,男12例,女3例;年龄20~57岁,平均35岁。受伤原因:交通意外伤10例,压砸伤3例,机器绞伤2例。损伤部位:单纯小腿损伤的11例,合并足部(包括内、外踝)4例。所有的创面均伴有肌腱的损伤、外露或骨缺损、骨外露。皮肤组织缺损面积18 cm×13 cm~28 cm×16 cm。急诊手术3例,择期手术12例。采用游离胸脐皮瓣修复缺损。结果〓术后带蒂胸脐皮瓣全部成活;1例远端皮缘坏死,经换药处理后痊愈。其中创面一期愈合有12例,二期愈合3例。结论〓胸脐皮瓣质好,供皮面积大,有利于治疗大面积缺损的下肢创面。

Free thoracoumbilical flap for repairing massive soft tissue defect associate with bone exposure of lower extremities (Report of 15 cases)

Objective To introduce the method and experience of free thoracoumbilical flap for repairing soft tissue defect of lower extremities. Methods Fifteen patients（male 12 cases, female3 cases, and aged 21-56 years old） with soft tissue defect of lower extremities were reported between2009 and 2012, including 10 cases of traffic accident injury, 3 cases of crush injury and 2 cases of machine injury. Of 15 cases, the sites of the soft-tissue defects included shank region in 11 cases,lower leg（including internal, external malleolus） in 4 cases. The defect size was 18 cm × 13 cm in length to 28 cm × 16 cm in width. All soft tissue losses were filled with free thoraco-umbilical flap.Results All pedicled thoraco-umbilicus flaps survived. Vascular crisis postoperation occurred in one case due to arterial embolization in donor, and healed by autogenous vein graft. Distal part skin necrosis was found in one case and recovered after dressing change. Conclusion Free thoracoumbilical flap can supply a large and high quality skinflap for repairing soft tissue defect of compex extremity trauma.