髂骨瓣串联股前外侧皮瓣一期修复足部第一跖骨与大面积皮肤软组织缺损  

ILIAC FLAP COMBINED WITH ANTEROLATERAL THIGH FLAP FOR REPAIR OF FIRST METATARSAL BONE AND LARGE SKIN DEFECT

作　　者：郭佳[1] 刘勇[2] 刘晓辉[2] 隋志强[2] 张雪涛[2] 王蕾[2] 

机构地区：[1]潍坊医学院外科学教研室,山东潍坊261053 [2]解放军第89医院骨科研究所

出　　处：《中国修复重建外科杂志》2016年第11期1400-1403,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：中国人民解放军后勤科研项目(CJN 15 J 046)~~

摘　　要：目的探讨采用髂骨瓣串联股前外侧皮瓣一期修复足部第1跖骨与大面积皮肤软组织缺损的方法及疗效。方法 2013年1月-2016年1月,采用髂骨瓣串联股前外侧皮瓣一期修复9例足部第1跖骨与大面积皮肤软组织缺损。男5例,女4例;年龄10~60岁,中位年龄15岁。致伤原因:交通事故伤6例,机器挤压伤3例。受伤至手术时间为3 h^14 d,平均7 d。皮肤软组织缺损范围为10 cm×6 cm^20 cm×10 cm。均伴第1跖骨缺损,缺损范围为2 cm×1 cm^5 cm×1 cm。术中髂骨瓣切取范围为3.0 cm×1.5 cm^6.0 cm×1.5 cm,皮瓣切取范围为10 cm×6 cm^20 cm×10 cm。供区直接缝合或游离植皮修复。结果术后复合组织瓣均顺利成活,创面Ⅰ期愈合;供区植皮均成活,切口Ⅰ期愈合。患者均获随访,随访时间6个月~2年,平均1.6年。X线片复查示,骨愈合时间为3.5~5.0个月,平均4个月。皮瓣质地柔软、颜色与周围正常组织相似。患者均行走正常。末次随访时,根据美国矫形足踝协会(AOFAS)足评分标准评定患足功能,获优6例,良3例,优良率100%。结论髂骨瓣联合股前外侧皮瓣可一期修复第1跖骨与大面积皮肤软组织缺损,术后足部功能外形恢复良好。ObjectiveTo investigate the surgical methods and effectiveness to use the iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect. MethodsBetween January 2013 and January 2016, iliac flap combined with anterolateral thigh flap was used to repair the first metatarsal bone and large skin defect in 9 patients. There were 5 males and 4 females, with a median age of 15 years （range, 10 to 60 years）. The causes included traffic accident injury in 6 cases and crush injury of machine in 3 cases. The average time from injury to operation was 3 hours to 14 days （mean, 7 days）. The size of skin soft tissue defect ranged from 10 cm×6 cm to 20 cm×10 cm. The size of first metatarsal bone defect ranged from 2 cm×1 cm to 5 cm×1 cm. The size of iliac flap was 3.0 cm×1.5 cm to 6.0 cm×1.5 cm, and the size of anterolateral thigh flap was 10 cm×6 cm to 20 cm×10 cm. The donor site was directly sutured or repaired by free skin graft. ResultsAfter operation, the composite flaps survived with primary healing of wound; the skin grafts at donor site survived and the incision healed by first intention. All patients were followed up 6 months to 2 years （mean, 1.6 years）. X-ray examination showed that the bone healing time was 3.5-5.0 months （mean, 4 months）. The flap had soft texture, good color and appearance. All patients could normally walk. According to the American Orthopaedic Foot and Ankle Society （AOFAS） standard, the foot function was excellent in 6 cases and good in 3 cases, and the excellent and good rate was 100% at last follow-up. ConclusionThe iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect is a practical way with good shape at one stage.

关 键 词：髂骨瓣 股前外侧皮瓣 第1跖骨 软组织缺损 创面修复 

分 类 号：R658.3[医药卫生—外科学]