不同组织瓣修复小腿皮肤软组织缺损伴骨外露  

The different tissue flaps for repairing leg soft tissue defect with bone exposure

作　　者：程二林 阿不来提·阿不拉[1] 王鑫[1] 任鹏[1] CHENG Er-lin;Abulaiti·Abula;WANG Xin;REN Peng(Dept of Microsurgical Repair Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830054,China)

机构地区：[1]新疆医科大学第一附属医院显微修复外科,新疆乌鲁木齐830054

出　　处：《临床骨科杂志》2022年第3期393-397,共5页Journal of Clinical Orthopaedics

基　　金：新疆维吾尔自治区自然科学基金(编号:2020D01C250)。

摘　　要：目的探讨不同组织瓣修复小腿皮肤软组织缺损伴骨外露的临床疗效。方法将252例小腿皮肤软组织缺损伴骨外露患者采用以下方法修复:(1)178例采用不同供血方式的小腿带蒂皮瓣修复,其中腓肠神经营养血管皮瓣修复74例,腓动脉穿支蒂腓肠神经营养血管皮瓣修复26例,腓动脉穿支皮瓣修复6例,胫后动脉穿支皮瓣修复72例。(2)36例采用游离皮瓣修复,其中股前外侧游离皮瓣移植30例,背阔肌游离肌皮瓣移植修复6例。(3)38例采用比目鱼肌肌瓣转位加皮片修复。结果患者均获得随访,时间5~72个月。术后16例不同供血方式的小腿带蒂皮瓣部分坏死,其中15例为腓肠神经营养血管皮瓣修复,1例为胫后动脉穿支皮瓣修复;2例游离皮瓣或肌皮瓣发生血管危象,其中1例股前外侧游离皮瓣发生静脉危象,1例背阔肌游离肌皮瓣发生静脉危象;比目鱼肌肌瓣转位加皮片移植全部成活。末次随访时,缺损创面愈合,皮瓣、肌皮瓣外观均有轻度臃肿,患者恢复行走功能。结论对于小腿皮肤软组织缺损伴骨外露的修复,术前必须仔细评估创面的位置、大小及周围血管的情况,选择较为安全、有效、合适的皮瓣修复,再加上个性化处理原则才能达到满意的临床疗效。Objective To investigate the clinical effect of different skin flaps in repairing skin and soft tissue defects of legs with bone exposure.Methods The 252 cases who suffered from lower legs skin soft tissue defects with bone exposure,were repaired by the following methods:(1)The 178 cases were repaired by leg pedicled skin flaps with different modes of blood supply,of which 74 cases were adopted with sural nerve nutrient vessels flaps,26 cases were used peroneal artery perforator pedicle sural nerve nutrient vessels flaps,and 6 cases were used peroneal artery perforator flaps,72 patients were repaired with posterior tibial artery perforator flaps.(2)The 36 cases were repaired with free flaps,including 30 cases with anterolateral femoral free flaps and 6 cases with latissimus dorsi free myocutaneous flaps.(3)The 38 cases were repaired with soleus muscle flap transposition and skin slice.Results All patients were followed up for 5~72 months.After operation,16 cases of pedicled flaps with different blood supply methods were partially necrotic,including 15 cases of sural nerve nutrient vessel flaps and 1 case of posterior tibial artery perforator flap.Vascular crisis occurred in 2 cases of free flap or musculocutaneous flap,including 1 case of anterolateral femoral free flap venous crisis and 1 case of latissimus dorsi free musculocutaneous flap venous crisis.All soleus muscle flap transposition and skin graft survived.At the last follow-up,the defect wound healed,the skin flap and myocutaneous flaps were slightly swollen,and the patients could walk.Conclusions For the choice of repair of leg skin and soft tissue defect with bone exposure,it is necessary to carefully evaluate the location and size of the wound and the situation of the surrounding blood vessels before surgery,and select a relatively safe,effective and appropriate flap repair,plus the principle of personalized treatment to achieve satisfactory clinical efficacy.

关 键 词：软组织缺损 骨外露 外科皮瓣 

分 类 号：R622.1[医药卫生—整形外科] R658.3[医药卫生—外科学]