三种交腿皮瓣修复小腿严重软组织缺损的临床疗效比较  

Clinical comparison of three different cross-leg flaps for coverage of serious soft tissue defects on the lower leg

作　　者：李舒琳 陆九州[1] 蒋军健[1] 徐雷[1] 

机构地区：[1]复旦大学附属华山医院手外科,上海200040

出　　处：《骨科》2016年第1期27-30,共4页ORTHOPAEDICS

基　　金：国家卫计委公益性行业科研专项项目(201402016)

摘　　要：目的探讨应用三种不同的交腿皮瓣修复小腿严重软组织缺损的临床效果。方法回顾性分析2012年7月至2014年12月于我科采用交腿皮瓣修复小腿严重软组织缺损的35例患者的临床资料,10例采用健侧胫后血管束桥接的游离股前外侧皮瓣移植的患者纳入股前外侧皮瓣组,15例采用腓肠神经营养皮瓣转移的患者纳入腓肠神经营养皮瓣组,10例采用小腿内侧穿支皮瓣转移的患者纳入穿支皮瓣组,比较三组患者术后的皮瓣成活情况、供区情况等。结果 34例皮瓣完全成活,1例部分成活。股前外侧皮瓣组发生1例感染;腓肠神经营养皮瓣组发生4例静脉危象、2例感染;穿支皮瓣组发生1例动脉危象。三组皮瓣成活情况差异无统计学意义(χ2=2.574,P=0.276);而三组间供区情况(闭合/植皮情况)的差异有统计学意义(χ2=18.177,P=0.000),股前外侧皮瓣组供区植皮率远远低于其他两种手术方式。结论三种不同交腿皮瓣修复小腿严重软组织缺损临床效果良好,可根据患者实际情况,选择合适的手术方式。Objective To evaluate the three different cross-leg flaps for repairing the serious tissue de-fect of the leg. Methods The clinical data of 35 patients with exposure wounds on the leg treated by cross-legflap were analyzed retrospectively. Ten cases with the posterior tibial vascular bundle of the posterior tibial ar-tery and the lateral femoral skin flap were included in the lateral femoral flap group. Fifteen cases with the trans-fer of the gastrocnemius nerve nutrient flap were included in the gastrocnemius nerve nutrient flap group. Tencases with medial leg perforator flap were included in the medial leg perforator flap group. The survival rate ofskin flaps and the supply area of the three groups were compared. Results Thirty-four cases survived com-pletely, and 1 cases survived partly. There was one case of infection in the lateral femoral flap group, 4 cases ofvenous crisis and 2 case of infection in the gastrocnemius nerve nutrient flap group, and 1 case of arterial crisisin the medial leg perforator flap group. There were no significant differences in survival rate of the flaps amongthe groups, but the condition of the supply area among the groups had significant differences. The rate of skingrafting in the lateral femoral flap group was lower than in the other two groups. Conclusion These three meth-ods of the cross-leg flap are safe and good way for repairing the soft tissue defects of the leg with reduced injuryof supply area at the same time.

关 键 词：皮瓣 软组织损伤 显微外科手术 移植 自体 小腿 

分 类 号：R658.3[医药卫生—外科学]