CAJ | 학술논문

目的观察应用带阔筋膜的股前外侧穿支组织瓣(筋膜瓣或筋膜皮瓣)显微移植修复多个部位复合组织缺损的临床效果. 方法 2008年2月-2012年8月,笔者单位采用带阔筋膜的股前外侧穿支组织瓣显微修复12例患者复合组织缺损,其中头皮恶性肿瘤切除后头皮、颅骨、硬脑膜缺损2例,跟后区及小腿皮肤、跟腱缺损3例,手背部皮肤、伸指肌腱缺损2例,足踝部皮肤、伸趾肌腱缺损合并骨外露或内固定钢板外露5例.组织瓣切取面积为12 cm×6 cm～19 cm×18 cm.供瓣区直接拉拢缝合或植皮修复. 结果 12例组织瓣术后全部成活,经2～36个月随访,局部外形、质地、功能良好.其中2例头皮恶性肿瘤切除后的头皮、颅骨、硬脑膜缺损修复,肿瘤无复发,脑组织无膨隆外疝；3例跟后区及小腿皮肤、跟腱缺损修复后,足部提踵功能得以重建,按Arner-Lindholm评定法评为优2例、良1例；2例手背部皮肤、伸指肌腱缺损,手指伸指功能按中华医学会手外科学会手部肌腱修复后评定标准均达到良；5例足踝部皮肤、伸趾肌腱缺损合并骨外露或内固定钢板外露修复后,足趾背伸功能得到重建和改善. 结论将带阔筋膜股前外侧穿支组织瓣显微移植用于颅骨和硬脑膜缺损修复、跟腱缺损再造、重建足提踵功能及在手足部伸指(趾)肌腱缺损再造修复,是一种有效方法.
목적 관찰응용대활근막적고전외측천지조직판(근막판혹근막피판)현미이식수복다개부위복합조직결손적림상효과. 방법 2008년2월-2012년8월,필자단위채용대활근막적고전외측천지조직판현미수복12례환자복합조직결손,기중두피악성종류절제후두피、로골、경뇌막결손2례,근후구급소퇴피부、근건결손3례,수배부피부、신지기건결손2례,족과부피부、신지기건결손합병골외로혹내고정강판외로5례.조직판절취면적위12 cm×6 cm～19 cm×18 cm.공판구직접랍롱봉합혹식피수복. 결과 12례조직판술후전부성활,경2～36개월수방,국부외형、질지、공능량호.기중2례두피악성종류절제후적두피、로골、경뇌막결손수복,종류무복발,뇌조직무팽륭외산；3례근후구급소퇴피부、근건결손수복후,족부제종공능득이중건,안Arner-Lindholm평정법평위우2례、량1례；2례수배부피부、신지기건결손,수지신지공능안중화의학회수외과학회수부기건수복후평정표준균체도량；5례족과부피부、신지기건결손합병골외로혹내고정강판외로수복후,족지배신공능득도중건화개선. 결론 장대활근막고전외측천지조직판현미이식용우로골화경뇌막결손수복、근건결손재조、중건족제종공능급재수족부신지(지)기건결손재조수복,시일충유효방법.
Objective To observe the clinical effects of repair of complicated tissue defects of several body parts with composite anterolateral femoral fascia lata perforator tissue flaps (fascial flap or fascial skin flap)with the aid of micro-surgery.Methods From February 2008 to August 2012,complicated tissue defects in 12 patients were repaired with composite anterolateral femoral fascia lata perforator tissue flaps.Two of the 12 patients suffered from a defect of scalp,skull,and dura mater as a result of resection of a malignant tumor of the scalp ; 3 patients showed a defect of skin and tendo calcaneus in the heel and lower leg; 2 patients showed a defect of skin and extensor tendon in the dorsum of hands; the other 5 patients suffered from defects of skin and extensor tendon in the foot and ankle combined with exposure of bone or internal buttress plate.The size of tissue flaps ranged from 12 cm × 6 cm to 19 cm × 18 cm.The donor sites were closed by immediate suturing or skin grafting.Results All 12 tissue flaps survived.Patients were followed up for 2 to 36 months.The flaps were shown to have good appearance,texture and function.Two patients with the defect of the scalp,skull and dura mater after a resection of the malignant tumor of the scalp did not have recurrence or herniation of brain tissue.The foot-raising function in 3 patients with the defect of skin and tendo calcaneus in the heel and lower leg was recovered,and according to Arner-Lindholm criteria the result was excellent in 2 cases and good in 1 case.The extension function of fingers of 2 patients with defects of skin and extensor tendon in the dorsum of hands was good according to the evaluation criteria of Chinese Medical Association Society of Hand Surgery for tendon repair of hand.The extension function of toes of 5 patients with defects of skin and extensor tendon in the foot and ankle combined with exposure of bone or internal buttress plate was recovered and improved.Conclusions Transplantation of composite anterolateral femoral fascia lata perforator tissue flaps with the aid of micro-surgery is an effective method in repairing the tissue defects of skull,dura mater,and the extensor tendon of hands or feet,with restoration of the extension function.