游离腹直肌瓣加植皮修复小腿及足踝部软组织缺损

目的探讨应用游离腹直肌瓣加中厚游离植皮修复小腿和足踝部软组织缺损的方法和疗效.方法 1998年5月～2002年12月,采用以腹壁下动、静脉为蒂的一侧腹直肌瓣游离移植加中厚植皮修复2例小腿、9例足踝部因外伤所致软组织缺损伴有骨、肌腱外露及骨髓炎患者.病程为1个月～10年.缺损范围3 cm×4 cm～8 cm×14 cm;切取腹直肌瓣4 cm×6 cm～8 cm×15 cm.结果术后11例移植肌瓣均成活,8例创口Ⅰ期愈合,3例移植中厚皮片坏死经再植皮后愈合.11例术后获随访6个月～4年,外形及功能良好.结论游离腹直肌瓣加中厚游离植皮修复小腿与足踝部软组织缺损具有血运好、抗感染力强和顺应性好等优点,可用于填充缺损及修复不规则创面,术后外形良好,克服了肌皮瓣肥厚臃肿的缺点.

RECONSTRUCTION OF LEG AND ANKLE DEFECTS BY USING FREE RECTUS ABDOMINIS MUSCLE FLAPS WITH INTERMEDIATE SPLIT THICKNESS SKIN GRAFT

OBJECTIVE: To study the method and effect of free rectus abdominis muscle flaps with intermediate split thickness skin graft in repairing defects on legs and ankles. METHODS: From May 1998 to December 2002, 11 cases of defects on legs (2 cases) and on ankles (9 cases) were repaired by use of unilateral free rectus abdominis flap with skin graft. The soft tissue defects were accompanied by osteomyelitis or the exposure of bone or tendon. The disease course was 1 month to 10 years. The defect size ranged 3 cm x 4 cm to 8 cm x 14 cm. The area of rectus abdominis muscle flaps was 4 cm x 6 cm to 8 cm x 15 cm. RESULTS: All patients were followed up 6 months to 4 years after operation. All rectus abdominis flaps survived with good appearances and functions. The primary healing was achieved in 8 cases, intermediate split thickness skin graft necrosed in 3 cases and the wound healed after skin re-graft. CONCLUSION: Free rectus abdominis flap is a proper option for repair of the soft tissue defects or irregular wounds on legs and ankles. It has the advantages of abundant blood supply, strong anti-infection ability, good compliance and satisfied appearance.