摘要
目的:腓肠肌肌皮瓣因受到蒂部长度限制,只能修复小腿中上部的皮肤软组织缺损,难以修复中下部的软组织缺损。采用推移腓肠肌肌皮瓣移植的方法,观察其修复小腿中下部软组织缺损的临床效果。方法:选择2000-02/2006-10应用推移腓肠肌肌皮瓣移植修复小腿中下部软组织缺损患者14例,软组织缺损范围为12.0cm×6.5cm￣4.5cm×3.5cm,均知情同意。只保留内和/或外侧腓肠血管蒂,切开肌皮瓣周围皮肤及切断腓肠肌的起止点,形成岛状腓肠肌内和/或外侧腓肠肌肌皮瓣,在屈膝30°￣60°时,肌皮瓣能明显向远端、前端推移4￣10cm,修复至中小腿下段创面,腓肠肌肌皮瓣最大为26.0cm×8cm,最小为13.0cm×4.5cm。术后定期随访。结果:所有病例均随访半年以上,12例肌皮瓣完全成活;2例远端部分皮肤坏死,经清创及比目鱼肌肌瓣转移填塞、中厚皮植皮愈合。术后有4例皮肤裂开,2例经换药愈合;1例用局部皮瓣转移修复;1例再行取钢板及清创后伤口愈合。结论:推移腓肠肌肌皮瓣能明显延伸向小腿远、前方,达小腿下段,血运丰富,转移方便,适应症广,是移植修复小腿中下部软组织缺损的一种优良供区。
AIM： Due to the limitation of pedicle length, gastrocnemius myocutaneous flap （GMF） can only repair the soft tissue defect in superior and middle lower legs, but it is ineffective for that in middle and inferior lower legs. This study is designed to explore the clinic value of extending GMF to repair the soft tissue defect of middle and inferior lower legs. METHODS： Fourteen patients with the soft tissue defect of middle and inferior lower legs underwent the transplantation of extending GMF from February 2000 to October 2006. Informed consents were obtained from all the patients. The scope of soft tissue defect was 12.0 cm×6.5 cm to 4.5 cm×3.5 cm, only restoring interior and/or lateral vessel pedicle. Skin surrounding GMF was excised, both origin and end points of gastrocnemius were cut off to form the interior and/or lateral GMF, which was island-shaped. At the angle of bending knee joint for 30°-60°, GMF extended 4-10 cm distally and anteriorly. The area of the largest GMF was 26.0 cm×8.0 cm, while that of the smallest one was 13.0 cm×4.5 cm. All the cases were followed up postoperatively. RESULTS： All the cases were observed over 6 months postoperatively, GMF in 12 cases survived completely; 2 cases presented skin necrosis in distant part and heeled after debridement, transferment of soleus muscular flap and skin graft. There were 4 cases occurring wound rupturing, among them, 2 cases heeled after changing dressings, 1 case heeled after transferring the adjacent flap, and 1 case heeled after removing steel plate and debridement. CONCLUSION： It is an ideal way to repair the soft tissue defect of middle and inferior lower legs with extended GMF. This operation extends obviously to the forward and distant position of the leg, provides well for blood circulation, transfers conveniently and prefers widely.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第43期8776-8778,共3页
Journal of Clinical Rehabilitative Tissue Engineering Research
