同侧比目鱼肌肌瓣逆行移位修复Pilon骨折术后软组织缺损

目的探讨采用同侧比目鱼肌肌瓣逆行移位修复Pilon骨折术后软组织缺损的临床效果。方法2002年5月～2006年6月，采用同侧比目鱼肌肌瓣逆行移位修复14例软组织缺损患者。男11例，女3例；年龄20～50岁。软组织缺损范围7．0cm×3．5cm～10．0cm×6．0cm。9例为Pilon骨折钢板内固定术后，5例为开放性Pilon骨折软组织缺损外固定术后。肌瓣切取范围为8．5cm×5．5cm～12．5cm×7．5cm。结果患者术后伤口均I期愈合，植皮均成活。2例肌瓣轻度感染，经换药后愈合；余肌瓣均成活。术后11例获随访3～26个月，平均15个月。植皮无破溃，外形无明显臃肿。踝关节活动范围背屈10-25^o，跖屈15-40^o，步态正常。结论逆行比目鱼肌肌瓣手术时不需显露血管蒂，解剖恒定，且比目鱼肌肌腹大，移位方便，旋转弧度可达180^o，且很少发生血管危象，促进创面愈合及骨痂生长，有利于降低伤口感染率。

REPAIR OF SOFT TISSUE DEFECT BY REVERSE SOLEUS MUSCLE FLAP AFTER PILON FRACTURE FIXATION

OBJECTIVE: To investigate the clinical effect of the reverse transposition of pedicled soleus muscle flap in repairing soft tissue defects after Pilon fracture fixation. METHODS: From May 2002 to June 2006, 14 patients (11 males, 3 females; aging 20-50 years) with soft tissue defects after Pilon fracture fixation underwent repairing operations with the reverse soleus muscle flaps. The soft tissue defects ranged from 7.0 cm x 3.5 cm to 10.0 cm x 6.0 cm. Of the patients, Pilon fractures were treated by internal fixations in 9 cases, open Pilon fractures were treated by external fixations in 5 cases. The area of muscle flap ranged from 8.5 cm x 5.5 cm to 12.5 cm x 7.5 cm. RESULTS: All patients achieved primary healings, and the grafting skin survived. Twelve flaps survived completely but 2 flaps had mild infection, which survived after dressing change. Eleven patients were followed up for 3 to 26 months, averaged 15 months. The flap appearances were good and smooth without ulceration. The dorsiflexion ranges of ankle joint were 10-25 degrees, and plantar flexion ranges were 15-40 degrees. The gait was normal. CONCLUSION: The reverse soleus muscle flap is no need to reveal blood vessel pedicle and has constant position of anatomy. It has big muscle belly, convenient-to-move and circuitation 180 degrees. It is profitable to reduce infection rate and to promote wound healing to raise local osteotylus.