胫后血管蒂小腿内侧复合组织瓣的临床应用  

CLINICAL APPLICATION OF THE MEDIAL MULTIPLEX FLAP PEDICLED WITH THE POSTERIOR TIBIAL VESSEL

作　　者：柳昊[1] 叶澄宇[1] 余国荣[2] 

机构地区：[1]温州医学院附属第一医院,浙江温州325000 [2]湖北医科大学附属第二医院显微外科

出　　处：《中国修复重建外科杂志》2001年第3期147-149,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的　探讨以胫后血管为蒂小腿内侧复合组织瓣的临床应用效果和有关问题。方法　 1992年 9月～ 1999年 5月应用小腿内侧复合组织瓣修复四肢骨和软组织缺损 12例 ,其中开放性骨折并骨和软组织缺损 7例 ,慢性溃疡并骨髓炎 2例 ,恶性黑色素瘤 2例 ,骨肿瘤切除术后骨和软组织缺损 1例。缺损范围 2 .5 cm× 5 .0 cm～4.5 cm× 11.0 cm。游离移植 5例 ,桥式转移 3例 ,逆行移位 4例 ,其中骨膜肌皮瓣加自体松质骨或同种异体脱钙骨移植 8例 ,肌皮瓣 4例。皮瓣最大 12 cm× 2 5 cm,最小 6 cm× 8cm。结果　 10例皮瓣全部成活 ,创面 期愈合 ;2例皮瓣远端小部分坏死 ,经切除坏死痂皮后换药 ,创面 期愈合。10例创面修复后 16周 X线片示骨愈合。术后经 6～18个月随访 ,除 1例术后 2个月死于肿瘤转移外 ,其余均取得满意效果。结论　小腿内侧复合组织瓣血供充分 ,血管口径粗 ,蒂长 ,皮瓣切取面积大 。Objective To investigate the clinical results of the medial multiplex flap pedicled with the posterior tibial vessel. Methods Twelve cases with soft tissue defects and bone defects of limbs were treated with the medial multiplex flap pedicled with the posterior tibial vessel from September 1992 to May 1999. Among them, bone and soft tissue defects following opened fracture in 7 cases, chronic ulcer following chronic osteomyelitis in 2 cases, melanoepithelioma in 2 cases, bone and soft tissue defects following osteoma resection in 1 case. The bone defect area was from 2.5 cm×5 0 cm to 4.5 cm ×11 0 cm. Free graft was performed in 5 cases, bridged transposition in 3 cases and reversal transposition in 4 cases, among them, periosteal myocutaneous flap with autogenous or allogeneic bone grafting in 8 cases, myocutaneous flap in 4 cases. The area of the flaps from 6 cm ×8 cm to 12 cm ×25 cm. Results All flaps were healed by first intention, but in the distal fragments of bigger flaps were partially necrosed in 2 cases. In 10 cases bone healing were obtained after 16 weeks of operation according to the X ray photos. All cases were followed up from 6 to 18 months. All cases achieved satisfactory result but 1 case died because of lung metastasis of osteoma. Conclusion The multiplex graft pedicled with the posterior tibial vessel is an ideal graft for repairing the large soft tissue defects and bone defects, because it has such advantages as adequate blood supply, big vascular diameter, long pedicle and big dermatomic area.

关 键 词：复合组织瓣 胫后动脉 创面修复 软组织缺损 骨缺损 胫后血管蒂 

分 类 号：R622[医药卫生—整形外科]