改良延迟小腿内侧逆行筋膜皮瓣交腿移植修复下肢复杂创面(1)
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[摘要]目的:探讨小腿内侧逆行筋膜皮瓣经改良延迟处理后交腿移植修复下肢复杂创面的临床应用效果,并总结改良方法。方法:针对不同的创面修复要求分别对拟转移的健侧小腿内侧逆行筋膜皮瓣进行针对性改良延迟处理,交腿移植修复骨、肌腱、关节、钢板外露创面12个病例17个创面。结果:全部病例移植的皮瓣均一期完全成活,随访4个月～2年,骨折愈合,外固定架、钢板均去除,外形和功能恢复良好。结论:小腿内侧逆行筋膜皮瓣在进行改良性延迟处理后,交腿移植修复创面可获得更好外形和功能恢复,且操作简便,安全可靠。
[关键词]下肢;外伤;皮瓣;延迟处理;交腿皮瓣;移植
[中图分类号]R622 [文献标识码]A [文章编号]1008-6455(2010)08-1101-03
Repairing lower limb complex wounds with improved delayed reverse fascial flaps of
medial leg
WANG Bang-he,WANG Chun-lan,CAO Dongsheng,DING Hao,LI Xiao-jing,ZHANG Lin
(Department of Plastic and Cosmetic Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230032,Anhui,China)
Abstract:ObjectiveTo evaluate the improved delayed reverse fascial flaps of medial leg to construct complex wound.Methods7 patients with external fixator tibia exposure, 3 patients with 6 discontinuous wounds and 2 patients with 4 wounds on the pressure insoles were treated with especially designed and modified delayed reverse fascial flaps of medial leg. This option is due to the nearby tissue damage or the patency of only anterior tibial artery or posterior tibial artery.ResultsThe 17 flaps in 12 patients survived well,All cases were followed up 4 months to 2 years. All the fractures united,the external fixators and internal fixators were took off by operation.The fuction and shape is satisfied.ConclusionA good surgical effect can be achieved in the case of complex wound restoration with some modification on reverse fascial medial leg flap delay. It is simple,safe,reliable and can handle wound with external fixator and large,discontinuous wound.It can even get better restoration of fuction and shape. The disadvantages includes long hospital stay and maintaining cross-leg posture.
Key words:lower limb; trauma; flap; delayed transaction; cross-leg flap;transplantation;
因车祸、烧伤、手术、感染等致小腿、踝、足皮肤软组织缺损、趾缺血坏死等,常伴有骨、肌腱、关节外露,不能自行愈合或不能耐受负重,易破溃。在同侧肢体损伤严重,难以行局部皮瓣、肌皮瓣转移或游离皮瓣移植的情况下,甚至应用一期交腿皮瓣修复也存在较大风险或不利因素时,临床处理较为棘手。我科2004年3月～2010年3月,应用改良延迟处理的小腿内侧逆行筋膜皮瓣交腿移植治愈小腿、踝、足等骨、肌腱、关节外露或负重区创面12例17个创面,效果满意,报道如下。
1临床资料
本组12例,男8例,女4例,年龄7～62岁,其中外固定架区胫骨外露创面7例(其中左腿4例,右腿3例),不连续2个创面的病例3例6个创面(右腿2例,左腿1例),足底负重区不稳定瘢痕创面2例4创面(左右足各1例,本组病例做术中冰冻病理检查排除恶变) ......
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