游离股前外侧皮瓣联合胫骨骨滑移治疗小腿大段骨及皮肤软组织缺损  

Combined free anterolateral thigh flap and tibial bone transport for resurfacing large segmental bone and soft tissue defect of lower extremities

作　　者：张艳茂[1] 刘会仁[1] 张瑞红[1] 陈玉刚[1] 马铁鹏[1] 于占勇[1] 高烁[1] 吴学强[1] 刘建华[1] 王岩[1] 

机构地区：[1]唐山市第二医院手外科,063000

出　　处：《中华创伤杂志》2017年第2期129-133,共5页Chinese Journal of Trauma

摘　　要：目的探讨应用游离股前外侧皮瓣联合胫骨骨滑移治疗小腿大段骨及皮肤软组织缺损的临床疗效。方法采用回顾性病例系列研究分析2006年8月-2016年4月应用游离股前外侧皮瓣联合胫骨骨滑移治疗27例小腿大段骨及皮肤软组织缺损患者，其中男22例，女5例；年龄16—56岁，平均36岁。Gustito分型：ⅢB型11例，ⅢC型14例，小腿闭合骨折内固定术后骨及皮肤坏死、感染2例。小腿皮肤软组织缺损面积10．0cm×5．5cm-21．0cm×10．0cm；切取皮瓣面积13．0cm×7．5cm-23．0cm×11．0cm。骨缺损长度5．5—18cm；骨滑移长度6—21cm。先行股前外侧皮瓣游离移植覆盖创面进行保肢。伤口愈合后行Ilizarov环式外固定架固定胫骨截骨骨滑移术修复骨缺损，恢复下肢功能。观察皮瓣成活情况，记录伤口愈合时间及愈合到骨滑移时间，记录骨愈合指数，记录去除外固定架时间。采用Paley标准评估疗效。结果随访1—8年，平均4年。27例皮瓣全部成活，伤口愈合好，无破溃感染。伤口愈合时间1-18个月，平均4．5个月。伤口愈合至骨滑移时间1—4个月，平均1．5个月。骨愈合指数45-65d，平均55d。骨愈合去除外固定架时间10—39个月，平均24．5个月。滑移骨矿化好，胫骨形态满意，恢复下肢完全负重行走功能。依据Paley标准：优21例，良6例。结论游离股前外侧皮瓣联合胫骨骨滑移术具有骨及软组织供给量足、肢体功能和形态恢复满意等特点，是治疗小腿大段骨及皮肤软组织缺损的有效方法之一。Objective To investigate the clinical efficacy of free anterolateral thigh flap transport combined with tibia bone transport in reconstruction of large segmental bone and soft tissue defect of lower extremities. Methods This retrospective case series review included 27 patients sustaining large segmental bone and soft tissue defect of lower extremities admitted between August 2006 and April 2016. There were 22 males and 5 females, with a mean age of 36 years （range, 16-56 years）. Eleven patients were identified with Gustilo Ⅲ B type open injury, 14 Gustilo m c type open injury, and 2 large bone and soft tissue defects after internal fixation of the closed lower extremity fractures. Size of soft tissue defect was 10.0 cm×5.5 cm-21.0 cm×10.0 cm. Size of the flaps was 13.0 cm×7.5 cm-23.0 cm×11.0 cm. Length of bone defect was 5.5 - 18 cm and length of bone transport was 6 - 21 em. Anterolateral thigh flaps were employed for limb salvage. After wound healing, bone transport with the use of an Ilizarov ring external fixator was done to treat tibial bone defect. Flap survival, wound healing time, bone transport time, bone healing index and time of external fixator removal were recorded. Mineralization of regenerate bone was assessed using the bone healing index. Results were evaluated using the Pa｜ey scoring system. Results Mean follow-up period was 4 years （ range, 1-8 years）. All flaps survived and the wounds were healed without ulceration or infection. Mean time for wound healing was 4.5 months （range, 1-18 months ）. Time interval between wound healing and bone transport was 1-4 days （mean, 1.5 months）. Mean bone healing index was 55 days （range, 45-65 days）, demonstrating good bone mineralization. Mean time of external fixator removal was 24. 5 months （range, 10-39 months）. Shape of the tibia was satisfied. All patients were able to ambulate without use of an aid. According to the Paley scoring system, results were excellent in 21 patients and good in 6 patients. Conclusion Combined f

关 键 词：外科皮瓣 伊利扎罗夫技术 胫骨骨折 软组织损伤 骨缺损 

分 类 号：R687.3[医药卫生—骨科学]