毁损性弃用肢体复合组织瓣在严重交通伤创面修复中的应用  

De-boned composite tissue flaps used for repair of serious traffic accident injuries

作　　者：张肃祥[1] 陶圣祥[1] 余国荣[1] 喻爱喜[1] 胡祥[1] 陶宗飞[1] 雷鹏程[1] 孙文晋[1] 

机构地区：[1]武汉大学中南医院骨科,430071

出　　处：《中华创伤骨科杂志》2011年第11期1044-1047,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨毁损性弃用肢体复合组织瓣修复严重交通伤导致的大面积皮肤软组织缺损的疗效。方法自2006年1月至2009年12月共收治12例严重交通伤致肢体毁损并大面积皮肤软组织缺损患者，男8例，女4例；年龄9～55岁，平均31．8岁。复合组织瓣类型及修复部位：桡动脉毁损性弃用肢体复合组织瓣修复上肢毁损伤并头面部皮肤软组织缺损4例，上臂巨大毁损性弃用肢体复合组织瓣修复上肢毁损伤并颈、腋及侧胸腹部皮肤软组织缺损3例，足部及小腿毁损性弃用肢体复合组织瓣修复下肢毁损伤并对侧足部及小腿皮肤软组织缺损5例。上肢复合组织瓣面积为5cm×10cm～20om×30cm，下肢复合组织瓣面积为10cm×20cm～30cm×40cm。受伤至手术时间为2～7h，平均4．0h。结果12例移植毁损性弃用肢体复合组织瓣全部成活，其中3例皮瓣术后创面感染，经创缘负压封闭引流后愈合。术后12例患者全身状况良好，经13～25d（平均21d）创面愈合，6个月后8例患者受区可有两点辨别觉，4例恢复部分粗略触觉。12例患者术后获6～12个月（平均8个月）随访，移植皮瓣颜色、质地良好，外形不臃肿。结论毁损性弃用肢体复合组织瓣可彻底覆盖修复巨大创面，提高患者生存质量，是一种牺牲局部、保护整体的有效选择。Objective To report clinical outcomes of de-boned composite tissue flaps used in repair of massive soft tissue injuries caused by traffic accidents. Methods From January 2006 to December 2009, we used de-boned composite flaps to treat 12 patients with massive soft tissue injuries caused by traffic accidents. They were 8 males and 4 females, aged between 9 and 55 years old （average, 31.8 years） . We used 4 de-boned composite flaps with radial artery to repair smashed wounds at the upper limb plus soft tissue defects at the face and head, 3 large upper arm de-boned composite flaps to repair smashed wounds at the upper limb plus soft tissue defects at the neck, armpit and flank, 5 foot and lower leg de-boned composite flaps to repair smashed wounds at the lower limb plus soft tissue defects at the opposite foot and leg. The average area of upper limb composite flaps ranged from 5 cm × 10 cm to 20 cm × 30 cm; the average area of the lower limb flaps ranged from 10 cm ×20 cm to 30 cm ×cm. All the eases received operation in 2 to 7 hours （average, 4. 0 hours） after the accident. Results All the patients were in good systematical condition after operation and all the flaps survived. Three cases got wound infection which responded to sealed vacuum drainage. The wounds healed in an average time of 21 days （from 13 to 25 days）. Eight eases recovered two-point discrimination in the recipient area 6 months post-operation, and 4 recovered partial sense of touch. An average follow-up of 8 months （from 6 to 12 months） found the flaps in satisfactory outline and good quality. Conclusion Because de-boned composite flaps can thoroughly cover and repair massive soft tissue defects, they make a good balance between local invasion and whole cure to improve the patient＇s quality of life.

关 键 词：移植物 修复外科手术 创伤和损伤 

分 类 号：R65[医药卫生—外科学]