中国修复重建外科杂志

中国修复重建外科杂志

胫后动脉穿支远端蒂复合组织瓣修复小腿远端创面

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目的 探讨胫后动脉穿支远端蒂复合组织瓣修复小腿远端创面的方法及疗效。 方法 2014 年 9 月—2017 年 8 月,应用胫后动脉穿支远端蒂复合组织瓣修复 12 例小腿远端皮肤软组织缺损合并骨缺损。男 8 例,女 4 例;年龄 25~66 岁,平均 41.3 岁。致伤原因:交通事故伤 7 例,重物砸伤 2 例,胫骨骨髓炎并软组织溃疡、坏死 2 例,骨肿瘤切除术后骨和软组织缺损 1 例。8 例一期修复,4 例二期修复。皮瓣切取范围为 6 cm×4 cm~10 cm×7 cm,肌瓣切取范围为 4.0 cm×2.5 cm~8.0 cm×6.0 cm,骨瓣切取范围为 4 cm×2 cm×2 cm~5 cm×4 cm×4 cm;供区胫骨骨缺损均采用自体髂骨植骨修复,创面直接拉拢缝合 7 例、部分缝合后游离植皮修复 5 例。 结果 术后 12 例胫后动脉穿支远端蒂复合组织瓣均成活,供、受区创面均Ⅰ期愈合。患者术后均获随访,随访时间 6~12 个月,平均 10.8 个月。复合组织瓣外观、颜色、质地及踝关节功能均满意。术后 6 个月 X 线片复查示骨瓣修复胫骨骨缺损处愈合良好,供区髂骨修复骨缺损处愈合良好。 结论 胫后动脉穿支远端蒂复合组织瓣血供丰富,是修复小腿远端局部软组织缺损合并局限性骨缺损创面的良好供区。

Objective To investigate the clinical application and effectiveness of the composite tissue flaps pedicled with perforating branch of posterior tibial artery for repairing distal leg defects. Methods Between September 2014 and August 2017, 12 patients with skin and bone defects of distal leg were repaired with the composite tissue flaps pedicled with perforating branch of posterior tibial artery. There were 8 males and 4 females with an average age of 41.3 years (range, 25-66 years). The causes of injury included traffic accident injury in 7 cases, heavy crushing injury in 2 cases, tibial osteomyelitis with soft tissue ulcer and necrosis in 2 cases, and bone and soft tissue defect after resection of bone tumor in 1 case. Eight patients underwent primary repair, and 4 patients underwent second-stage repair. The size ranged from 6 cm×4 cm to 10 cm×7 cm in skin flap, from 4.0 cm×2.5 cm to 8.0 cm×6.0 cm in muscle flap, and from 4 cm×2 cm×2 cm to 5 cm×4 cm×4 cm in tibial bone flap. Tibial defects of the donor region were repaired by autologous iliac bone grafting, and the wounds were sutured directly in 7 cases and repaired by autologous skin grafting in 5 cases. Results All composite tissue flaps survived and both the recipient and the donor wounds healed primarily. All patients were followed up 6-12 months, with an average of 10.8 months. The appearance, color, texture of the composite tissue flaps and ankle function were satisfactory. X-ray films showed that the bone flap at the tibia defect and the ilium graft at the donor site both healed well at 6 months after operation. Conclusion The composite tissue flaps pedicled with perforating branch of posterior tibial artery has abundant blood, and it is a good donor region for repairing the distal leg defects combined with circumscribed bone defect.

关键词: 胫后动脉; 复合组织瓣; 复合组织缺损; 创面修复

Key words: Posterior tibial artery; composite tissue flap; compound tissue defect; wound repair

引用本文: 陈长顺, 胡祥, 郑前进, 段勇, 刘思怡, 陶圣祥. 胫后动脉穿支远端蒂复合组织瓣修复小腿远端创面. 中国修复重建外科杂志, 2019, 33(1): 75-79. doi: 10.7507/1002-1892.201805093 复制

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