半比目鱼肌带蒂肌瓣修复小儿胫前软组织缺损  

Repair of pretibial soft tissue defects in children with a medial hemisoleus pedicle muscle flap

作　　者：张功林[1] 甄平[1] 陈克明[1] 张军华[1] 王世勇[1] 

机构地区：[1]兰州军区总医院骨科研究所,730050

出　　处：《中华小儿外科杂志》2014年第1期28-31,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的总结内侧半比目鱼肌带蒂肌瓣修复小儿胫前软组织缺损的临床应用结果。方法2006年10月至2012年10月应用内侧半比目鱼肌带蒂肌瓣修复8例小儿胫前软组织缺损，男6例，女2例，年龄4～12岁，平均7．5岁。均为胫前软组织缺损伴骨或肌腱外露的创面，左侧5例，右侧3例。其中6例伴有胫骨中段骨折。软组织缺损面积：4．0cm×3．5cm～8．0cm×4．0cm。创面部位：小腿中上端3例，中段5例。4例急诊手术修复，4例择期手术修复。肌瓣表面行一期中厚网状游离植皮，供区直接缝合。结果所有的肌瓣全部成活，取得了满意的临床效果。1例受区创缘去除引流条后每天从引流孔有少量渗出液流出，经2周换药处理自行愈合。随访1．5～4年，平均2．5年，6例伴有胫骨骨折者骨折全部愈合。结论内侧半比目鱼肌带蒂肌瓣具有血管解剖恒定、血运丰富以及操作简单等优点，适宜修复小儿胫前软组织缺损。Objective To summarize our experience of repairing pretibial soft tissue defects in children with a medial hemisoleus pedicle muscle flap. Methods From October 2006 to October 2012, eight patients （6 boys, 2 girls） at a mean of 7. 5 years （range, 4-12 years） with pretibial soft tissue defects underwent reconstruction with a medial hemisoleus pedicle muscle flap. All wounds were complicated with bone or tendon exposure, on the left side in 5 cases, and on the right side in 3 cases. Six cases had tibia fractures in the middle third part. The surface area of soft tissue defects ranged from 4. 0 cm× 3. 5 cm to 8. 0 cm ×4. 0 cm. The location of the wounds was on the middle and upper third of lower leg in 3 cases and middle in 5 cases. Four patients underwent emergency surgery and 4 patients received elective surgery. Immediate coverage of the defects with muscle flaps was performed by a meshed split-thickness skin graft. The donor site was closed directly. Results All flaps survived completely with satisfactory clinical results. The recipient area in one case had a small amount of exudate from drainage hole everyday, however, after removing the drainage strip, the wounds healed spontaneously with the help of dressing change for 2 weeks. Tibial fractures in six patients also healed after followed up for an average of 2. 5 years （range, 1.5 to 4 y）. Conclusions The medial hemisoleus pedicle muscle flap is suitable for repairing of pretibial soft tissue defects in children because it has a constant vascular anastomy with highly vascularity,and is easy to harvest.

关 键 词：肌瓣 带蒂组织移植术 软组织损伤 

分 类 号：R726.8[医药卫生—儿科]