桥式游离背阔肌肌皮瓣联合VSD技术修复小腿Gustilo Ⅲ C型骨折创面  

Application of cross-bridge vacular anastomosis free latissimus dorsi musculocutaneous flap with vacuum sealing drainage in reconstruction of the defects in the lower extremity caused by the Gustilo Ⅲ C fracture

作　　者：林鹤[1] 郭宗科[1] 韩兵[1] 熊猛[1] 严婷婷 

机构地区：[1]东南大学附属中大医院烧伤整形科,江苏南京210009 [2]广东省皮肤病医院激光美容中心,广东广州510000

出　　处：《中国美容医学》2016年第2期1-4,共4页Chinese Journal of Aesthetic Medicine

摘　　要：目的：探索应用健侧胫后血管皮瓣蒂携带游离背阔肌肌皮瓣,修复主干血管受损的小腿Gustilo Ⅲ C型骨折的创面,以最大程度降低肢体受损程度,避免截肢。方法：2012年2月-2013年3月收治的6例患者,均因高能量创伤致小腿中下段胫腓骨开放性骨折,伴发血管损伤、皮肤、肌群坏死,胫骨外露。一期清除坏死组织后,使用创面封闭负压引流技术保护外露的骨骼、肌腱;二期采用切取背阔肌肌皮瓣借由健侧胫后血管皮瓣蒂桥接至患侧,填塞肌肉坏死产生的创腔,覆盖骨外露,修复创面。双足跟使用斯氏针对穿固定,防止下肢活动造成皮瓣损伤。4周后为断蒂进行血管蒂阻断训练,6-8周后手术断蒂。结果：6例桥式游离背阔肌肌皮瓣全部成活,愈合过程顺利,无血管危象、血肿、感染征象。肌皮瓣外观丰满,质地均匀。术后随访6-9个月,皮瓣质地柔软,外形良好,患肢足踝功能恢复满意。结论：创面封闭负压引流技术对创面的湿性保护和引流、抑菌等作用充分保护了创面外露组织;健侧胫后血管皮瓣蒂瓦合游离背阔肌肌皮瓣,对于修复小腿中下1/3严重的血管、肌肉、皮肤损伤,效果明显。二者结合应用可使小腿最大限度的恢复功能,降低损伤程度。Objective To explore the clinical value of free latissimus dorsi musculocutaneous flap and Vacuum Sealing Drainage（VSD） technology in reconstruction of massive soft tissue defects in calf caused by Gustilo Ⅲ C fracture is to avoid disability at utmost. Methods From February 2012 to March 2013,6 patients were suffered open fractures of tilia and fibula in calf by reason of high-energy trauma accompanying vessel damage,skin necrosis, muscle necrosis, tibia exposure. After first removing the necrosis and cleaning the wound,Vacuum Sealing Drainage was applied to cover the wound for temporary（1 to 2 weeks） to make sure the body had netheir necrosis nor serious infection.During the second operation, latissimus dorsi musculocutaneous flapped through the dorsum donor site with thoracodorsal artery and vein that were connected with the wounded part,which was to fill the cavity, cover the broken tibia.Two feet were bounded by steinmann pin to prevent lower extremity injuries.4 weeks later,the pedicle was trained with intermittent inflow occlusion preparing for division the pedicle which was finished in 6 to 8 weeks. Results All flaps survived completely and their wounds were healed primarily without vaso-occlusive crisis,hematoma,infection etc.Plump appearance and uniform texture were at outer muscle flaps.Follow-ups for 6 to 9 months showed that all the flaps survived with good quality and shape. The affected foot and ankle obtained good function. Conclusions Vacuum sealing drainage can protect the severe wound of Gustilo Ⅲ C fracture from deep damage.Reconstruction of massive soft tissue defects in distal one third of lower leg with free latissimus dorsi musculocutaneous flap which is supplied by posterior tibial vessels of the unjuryed contralateral side is a feasible and effective method. The method with two technology can effectively reduce the rate of limb disability,restore the limb function and shorten the course of treatment.

关 键 词：桥式瓦合 游离背阔肌肌皮瓣 封闭负压引流技术 GUSTILO Ⅲ C型骨折 

分 类 号：R622[医药卫生—整形外科]