前界、后界和(或)下界扩大的改良腓肠肌内侧头肌皮瓣的临床应用  

Modified medial gastrocnemius myocutaneous flap with extended anterior,posterior and(or)inferior boundaries:a clinical application

作　　者：张理军 魏建伟[2] 董忠根[2] 刘立宏[3] 陶世斌 熊珏铭 Zhang Lijun;Wei Jianwei;Dong Zhonggen;Liu Lihong;Tao Shibin;Xiong Jueming(Department of Orthopaedics,the Fourth Hospital of Changsha Integrated Traditional Chinese and Western Medicine Hospital of Changsha,Changsha 410006,China;Department of Orthopaedics,the Second Xiangya Hospital,Central South University,Changsha 410011,China;Department of Rehabilitation,the Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]长沙市第四医院(长沙市中西医结合医院)骨科,长沙410006 [2]中南大学湘雅二医院骨科,长沙410011 [3]中南大学湘雅二医院康复科,长沙410011

出　　处：《中华显微外科杂志》2025年第1期60-65,共6页Chinese Journal of Microsurgery

基　　金：湖南省自然科学基金(2022JJ30852)。

摘　　要：目的评价前界、后界和(或)下界扩大的改良腓肠肌内侧头肌皮瓣(MGMF)的临床疗效。方法2002年1月至2022年9月,在中南大学湘雅二医院骨科行改良MGMF修复膝周及小腿软组织缺损33例,创面大小10 cm×4 cm~22 cm×12 cm,皮瓣大小15 cm×6 cm~28 cm×14 cm,其中25例合并慢性骨髓炎。改良皮瓣切取范围:前界为胫骨前缘,后界为后正中线外侧3.0 cm,上界为腘窝横纹,下界为内踝尖上2.0 cm;皮瓣的前缘位于创面的内侧缘及其弧形延伸线上。小腿胫前皮肤等分为9个区段,从上至下分别为第1~9区。术后常规抗感染;所有患者通过门诊或电话、微信随访,评价皮瓣成活及供、受区创面愈合情况,患肢功能评价采用Punor等评定标准。结果本组术后随访1~169(中位时间9)个月。33例MGMF中,单纯前界扩大18例,单纯下界扩大5例,前界合并下界扩大6例,后界合并前界扩大2例,后界合并下界扩大2例。有29例(87.9%)皮瓣完全成活;4例(12.1%)部分坏死,单纯前界和单纯下界扩大的皮瓣各2例。皮瓣前界扩大26例(78.8%),其前缘超过胫骨内侧缘1.0~4.5(平均2.1)cm;14例(42.4%)皮瓣修复的创面累及小腿下1/3段(第7区8例,第8区6例)。皮瓣供区植皮均成活,随访期内,31例(93.9%)无感染征象,2例(6.1%)慢性骨髓炎复发。患肢功能按Punor评定,优25例,良6例,可2例。结论前界、后界和(或)下界扩大的改良MGMF是可行的,具有设计和操作更简便,可修复更远、更宽、更大面积创面的优点,拓宽了MGMF的适用范围。Objective To evaluate the clinical efficacy of the modified medial gastrocnemius myocutaneous flap(MGMF)with extended anterior,posterior and(or)inferior boundaries.MethodsFrom January 2002 to September 2022,modified MGMFs were applied onto 33 patients who received reconstructive surgery for soft-tissue defects around knee or in calf,in the Department of Orthopaedics,the Second Xiangya Hospital of Central South University.The size of defects ranged from 10 cm×4 cm to 22 cm×12 cm,and the flap size ranged from 15 cm×6 cm to 28 cm×14 cm.Twenty-five patients had the complication of chronic osteomyelitis.The boundaries of a modified MGMF were as follows:the anterior boundary was the anterior border of the tibia,where the posterior boundary at 3.0 cm lateral to the posterior midline,the proximal boundary at the popliteal fossa crease,and the distal boundary at the plane 2.0 cm above the tip of medial malleolus.The anterior edge of the modified MGMF was designed running along the medial edge of the defect and its curved extension line.Pretibial skin was equally divided into 9 zones,with the 1st to 9th zones from proximal to distal in sequence.Postoperative routine anti-infection treatment was offered.All patients were included in the postoperative follow-up through outpatient visits,telephone or WeChat interviews.Flap viability and wound healing in both donor and recipient sites were evaluated.Function of the affected limb was assessed using the evaluation criteria established by Punor et al.ResultsAll patients were included in the follow-up for 1 to 169(median duration:9)months.The 33 modified MGMFs included MGMFs with extended boundary of anterior(n=18),inferior(n=5),anterior combined with inferior(n=6),posterior combined with anterior(n=2),and posterior combined with inferior(n=2)boundaries.Twenty-nine(87.9%)flaps survived completely.Partial necrosis occurred in 4 flaps(12.1%)(2 flaps with extended anterior boundary and 2 flaps with extended inferior boundary).The anterior margins of 26 flaps(78.7%)with extended a

关 键 词：腓肠肌内侧头肌皮瓣 腓肠肌 肌皮瓣 膝 小腿 软组织缺损 

分 类 号：R687.3[医药卫生—骨科学]