CAJ | 학술논문

目的观察游离肌皮瓣与健肢胫后血管桥接修复对侧下肢软组织缺损的临床效果.方法 2006年2月至2013年6月,对10例小腿下段及足部软组织缺损患者,应用健肢胫后血管与游离背阔肌肌皮瓣、背阔肌肌皮瓣联合胸脐皮瓣、股前外侧肌肌皮瓣的血管吻合,形成以健肢胫后血管为蒂的顺行或逆行桥式皮瓣,交腿修复对侧小腿下段及足部大面积软组织缺损.创面面积40 cm×21 cm ～22 cm×15 cm,皮瓣切取面积48 cm×26 cm～25 cm×18 cm,供瓣区游离皮片移植.术后双小腿应用克式针分别在胫骨中上段及跟骨部位同定,4周后拔除克式针,双小腿进行功能锻炼,5～8周断蒂.其中6例患者皮瓣断蒂时行健肢胫后动脉再吻合.结果 10例患者的游离皮瓣均成活,3例皮瓣臃肿行二期皮瓣修薄术.术后随访3个月至2年,患肢行走功能逐渐恢复,外观满意,健肢再次吻合的胫后动脉通畅,未出现其他并发症.结论小腿下段及足部有广泛软组织缺损骨质外露患者,应用局部皮瓣或传统交腿皮瓣不能修复,且患侧肢体胫前或胫后动脉有1条受损,不能作为吻合血管行游离皮瓣移植者,可根据不同创面选择合适的游离肌皮瓣予以桥接移植修复,可降低截肢率,是一种安全有效的保肢修复方法.
목적 관찰유리기피판여건지경후혈관교접수복대측하지연조직결손적림상효과.방법 2006년2월지2013년6월,대10례소퇴하단급족부연조직결손환자,응용건지경후혈관여유리배활기기피판、배활기기피판연합흉제피판、고전외측기기피판적혈관문합,형성이건지경후혈관위체적순행혹역행교식피판,교퇴수복대측소퇴하단급족부대면적연조직결손.창면면적40 cm×21 cm ～22 cm×15 cm,피판절취면적48 cm×26 cm～25 cm×18 cm,공판구유리피편이식.술후쌍소퇴응용극식침분별재경골중상단급근골부위동정,4주후발제극식침,쌍소퇴진행공능단련,5～8주단체.기중6례환자피판단체시행건지경후동맥재문합.결과 10례환자적유리피판균성활,3례피판옹종행이기피판수박술.술후수방3개월지2년,환지행주공능축점회복,외관만의,건지재차문합적경후동맥통창,미출현기타병발증.결론 소퇴하단급족부유엄범연조직결손골질외로환자,응용국부피판혹전통교퇴피판불능수복,차환측지체경전혹경후동맥유1조수손,불능작위문합혈관행유리피판이식자,가근거불동창면선택합괄적유리기피판여이교접이식수복,가강저절지솔,시일충안전유효적보지수복방법.
Objective To observe the clinical effects of free musculo-cutaneous flap bridging with contralateral posterior tibial vessel on repair of lower extremity soft tissue defect.Methods From February 2006 to June 2013,10 patients with soft tissue defect on lower shank and foot were included.The posterior tibial vessel on healthy lower extremity was chosen as recipient vessel and anastomosed with free latissimus dorsi musculo-cutaneous flap,or free latissimus dorsi musculo-cutaneous flap combined with thoracic-umbilical skin flap or anterolateral femoral musculo-cutaneous flap.The retrograde bridged flap was transposed to repair defect on contralateral lower shank and foot.The wound area ranged from 40 cm × 21 cm to 22 cm×15 cm,with flap size from 48 cm×26 cm to 25 cm×18 cm.Meanwhile the defects on donor sites were covered with skin graft and both lower extremities were fixed with kirschner wires at middle tibia and calcaneus.The kirschner wires were removed at 4 weeks and pedicles were cut off 5 ～ 8 weeks postoperatively.Six patients received posterior tibial vessel reanastomosis at the same time of pedicle cutting.Results All the 10 flaps survived and 3 patients received thinning of flaps due to excessive thickness.During the follow-up period of 3 months to 2 years follow up,the ambulatory function of injured legs recovered gradually with satisfactory appearance.The reanastomosed posterior tibial vessel on the healthy side was recovered.Conclusions Appropriate bridged musculo-cutaneous flaps is suitable for extensive soft tissue defect of lower shank and foot.It is a safe and effective method for limb salvage.