比目鱼肌内侧半肌瓣修复胫骨及踝部开放骨折术后软组织缺损  

REPAIRING POSTOPERATIVE SOFT TISSUE DEFECTS OF TIBIA AND ANKLE OPEN FRACTURES WITH MUSCLE FLAP PEDICLED WITH MEDIAL HALF OF SOLEUS

作　　者：程超[1] 李晓天[1] 阿不都萨拉木 

机构地区：[1]大连医科大学附属第一医院骨外科,辽宁大连116011 [2]新疆克州人民医院骨科

出　　处：《中国修复重建外科杂志》2009年第12期1440-1442,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨比目鱼肌内侧半肌瓣修复胫骨及踝部开放骨折内固定术后软组织缺损的临床疗效。方法1998年2月-2009年1月,收治15例胫骨及踝部开放骨折内固定术后软组织缺损男性患者。年龄18～54岁,平均32岁。致伤原因:车祸伤13例,砸伤2例。左侧9例,右侧6例。软组织坏死伴脓性分泌物,骨与钢板均外露。软组织缺损位于胫骨上段2例,胫骨中下段9例,踝部4例;缺损范围5cm×4cm～13cm×6cm。内固定术后至此次手术时间为3～6个月,平均4个月。术中2例采用比目鱼肌内侧半肌瓣顺行移位修复缺损,13例采用逆行移位修复缺损;肌瓣切取范围5cm×4cm～13cm×5cm。14例采用大腿内侧中厚皮片覆盖肌瓣,皮片切取范围2.5cm×1.5cm～10.0cm×5.0cm;1例采用7cm×6cm的腓肠神经营养血管逆行岛状皮瓣移位覆盖肌瓣。结果术后5d1例皮片坏死,经再次清创、负压吸引、敷料覆盖植皮后愈合;其余患者创面均Ⅰ期愈合,植皮、皮瓣及肌瓣均成活。供区切口Ⅰ期愈合。术后13例获随访,随访时间为6个月～8年,平均3年。植皮无破溃,耐磨,外形无臃肿。末次随访时踝关节活动范围背伸5～10°,趾屈10～15°,呈强直步态。结论比目鱼肌内侧半肌瓣移位修复术手术操作简便,肌瓣移位旋转弧大,充填髓腔同时修复软组织缺损,且术后切口平整,不臃肿,供区损伤小,是修复胫骨及踝部开放骨折内固定术后软组织缺损的有效方法之一。Objective To investigate the therapeutic effect of repairing postoperative soft tissue defects of tibia and ankle open fractures with muscle flap pedicled with medial half of soleus. Methods From February 1998 to January 2009,15 male patients with postoperative soft tissue defects of internal fixation for tibia and ankle open fractures were treated. Their age was 18-54 years old （average 32 years old）. The injury was caused by traffic accident in 13 cases and hit of heavy objects in 2 cases. The injury was in the left side in 9 cases and the right side in 6 cases. The soft tissue was necrotic and combined with purulent secretion. All patients presented with exposure of bone and steel plate. The soft tissue defect was located on the upper-segment of tibia in 2 cases,the middle and lower-segments of tibia in 9 cases,and the ankle in 4 cases. The size of the defect was 5 cm × 4 cm-13 cm × 6 cm. The time from the internal fixation to the operation was 3-6 months （average 4 months）. The method of anterograde transposition of muscle flap pedicled with medial half of soleus was used to repair the defects in 2 cases,and the method of retrograde transposition was applied to repair the defects in 13 cases. The muscle flap harvested during operation was 5 cm × 4 cm-13 cm × 5 cm in size. The muscle flap was covered with split thickness skin graft （2.5 cm × 1.5 cm-10.0 cm × 5.0 cm） of femoribus internus in 14 cases,and island flap with nutritional vessel pedicle of sural nerve （7 cm × 6 cm） in 1 case. Results One case had skin graft necrosis 5 days after operation and healed after re-debridement,vacuum sealing drainage,and dermatoplasty. For the rest 14 patients,the incision all healed by first intention,and the skin graft,skin flaps,and muscle flaps were all survived. All wounds of the donor sites healed by first intention. Thirteen patients were followed up for 6 months to 8 years （average 3 years）. The grafted skin presented with good wearability and without ulceration and overstaffed appearance.

关 键 词：比目鱼肌内侧半肌瓣 胫骨 踝部 开放骨折 软组织缺损 修复 

分 类 号：R658[医药卫生—外科学]