足骨及软组织损伤缺损的组合组织修复临床研究

目的 研究解决足部创伤及疾病造成的足骨及软组织缺损的修复重建方法，减少和减轻足残疾和功能不良率，最大限度的恢复足功能和外型。方法 对于足背、前足、足跟、踝下等部位单纯软组织缺损，可采用局部转移或旋转皮支皮瓣、筋膜皮瓣，游离皮瓣，游离全厚植皮等方法修复；足底负重区采用预制皮瓣方法解决；前足、足跟及其它跗骨复合组织缺损采用带血管髂骨加皮瓣组合移植重建；内外踝缺损应予以重建。结果 247例患者经1．5～5年随访，按美国AOFAS踝一足评分标准：优84例，良107例，可42例，差14例。结论 髂骨用于重建再造跖骨缺损尤其是多跖骨缺损、跟骨缺损，稳定且触地面积大、承压小；内外踝可取带筋膜的髂骨和腓骨头重建骨及韧带缺损；组合带血管骨与皮瓣修复缺损，可恢复足的解剖和生理功能。

Repairing foot defects of bone and soft tissue with composite tissue transfer

Objective To discuss the methods for repair and reconstruction of foot defects in order to reduce the deformity and insufficiency of f oot and to restore its functional and cosmetic aspects.Methods 247cases were treated for their foot defects of bon e and /or soft tissue.The defects of s imple soft tissue at dorsum,forefoot,heel,and sub-ankle were repaired by local transfer or rotation of cutaneous br anch flap,fascial flap,and free ski n flap or free full-thickness skin-grafting.The plantar defects were repaired w ith prefabricated flaps.The compou nd defects at the forefoot,heel and tarsal bones were reconstructed by using vascularized iliac bone incorporated with fr ee flap transfer.Results All the 247cases achieved satisfactory clinical results.They were asse ssed according to USA foot-malleolus scores of AOFAS.84c ases were excellent,107good,42fair,and 14poor.Conclusions Being flat in shape and rich in blood supply,the iliac bone is a valuable supply b one for foot defects,especially mul -ti-metatarsal and calcaneal ones.Defects of malleolus should be reconstructed by free iliac bone or free fib ular head graft with fascial strip.Vascularized bone grafts incorporated with va scularized flaps provide an ideal me thod for re-construction of compound foot defects.[