胫后动脉穿支蒂嵌合组织瓣游离移植修复四肢骨与皮肤软组织缺损  

Free transplantation of the chimeric flap based on the perforator of the posterior tibial artery for reconstruction of bone and skin defect in extremities

作　　者：周明武[1] 李扬[2] 朱杰[1] 宋力[1] 熊颖杰[1] 张迅[2] 

机构地区：[1]解放军第153中心医院全军创伤骨科中心,郑州450007 [2]新乡医学院研究生处

出　　处：《中华显微外科杂志》2015年第4期342-346,共5页Chinese Journal of Microsurgery

基　　金：河南省科技攻关重点项目（102102310002）

摘　　要：目的 探讨应用胫后动脉（PTA）穿支蒂嵌合组织瓣修复四肢骨与皮肤软组织缺损的临床应用效果. 方法 2007年3月至2013年6月,对四肢骨缺损、骨不连伴皮肤软组织缺损者术前行小腿DSA,对胫后动脉中上段发出的较大穿支,采用彩色多普勒血流成像（CDFI）追踪其分支及走行,寻找穿支分别发出次级分支至皮肤和骨膜这一类型的穿支血管.根据受区骨缺损长度和皮肤软组织缺损面积,选择其中合适的胫后动脉穿支血管,设计并切取以该单一穿支为蒂,其分支分别携带骨瓣和皮瓣,形成穿支蒂嵌合组织瓣,游离移植修复骨与皮肤软组织缺损.本组共17例,手部创伤10例,小腿及足部损伤7例,骨瓣切取大小为1.5 cm×0.6 cm×0.4cm-4.0cm×2.0cm× l.0cm,皮瓣切取面积为2.0 cm×2.0 cm - 7.0 cm×6.0 cm. 结果 随访3- 18个月,穿支蒂嵌合骨瓣、皮瓣全部成活,供区愈合良好,其中9例皮瓣与周围组织几乎相平;8例不同程度臃肿,经二期去脂整形后与周围组织相平.骨移植修复骨缺损处,术后3-6个月骨折线消失,骨愈合良好.10例手部创伤患者,术后按照中华医学会手外科学分会相关评定标准评定：优7例,良2例,可1例.7例小腿及足部创伤患者,术后可负重行走且无疼痛. 结论 对于各种原因造成的四肢小段骨缺损伴皮肤软组织缺损,应用该术式,不牺牲知名血管,供区影响小,骨移植后愈合时间短而且不易吸收,是一种较为理想的修复方法.Objective To investigate the clinical effect of the chimeric flap based on the perforator of the posterior tibial artery for reconstruction of bone and skin defect in extremities.Methods From March,2007 to June,2013,the legs of the patients with bone nonunion,bone defect and skin soft tissue defect in extremities accepted digital subtraction angiography to find the larger perforators in the upper middle section of posterior tibia1 artery.Color doppler flow imaging （CDFI） was used to track branches and directions of the larger perforators and to look for the perforators which gave off secondary branches respectively to the skin and periosteum.According to the length of bone defect and the area of skin defect,the composite flap with the bone flap and skin flap was designed and cut out.It was based on the right single perforator of the posterior tibial artery which was chosen.The free composite flap was called the chimeric flap based on the perforator of the posterior tibial artery and repaired bone and skin defect in extremities.The size of osseous flaps ranged from 1.5 cm × 0.6 cm × 0.4 cm to 4.0 cm × 2.0 cm × 1.0 cm,and the size of cutaneous flaps of total 17 cases ranged from 2.0 cm × 2.0 cm to 7.0 cm × 6.0 cm.Results Followed-up for 3 to 18 months,all osseous flaps and cutaneous flaps survived,and all donor sites healed well.Nine cases of all cutaneous flaps were flat with the surrounding tissue and others bloated,but they were flat with the surrounding tissue after second phase to fat plastic.The fracture line disappeared and bone healed well at the time of 3-6 months after operation of bone graft to repair bone defect.According to the related evaluation criteria made by the Chinese Medical Association,the results of 10 cases of hand trauma patients were excellent in 7 cases,good in 2 cases,may in 1 case.Seven cases of lower leg and foot trauma patients could walk with load without pain.Conclusion Application of the chimeric flap based on the perforator of the posterior tibia1 artery is an ideal meth

关 键 词：骨缺损 胫骨 胫后动脉 穿支 嵌合组织瓣 显微外科手术 

分 类 号：R658[医药卫生—外科学]