摘要
目的对比修薄的背阔肌肌瓣游离移植联合植皮术和传统背部皮瓣游离移植术在修复足背部软组织缺损中的治疗效果。方法选取2005年1月至2019年12月解放军总医院第一医学中心整形修复科收治的伴有不同程度肌腱和骨质外露的足背软组织缺损患者。纳入标准:单侧足背、踝部软组织缺损,伴有肌腱和(或)骨骼外露,无法采用植皮、局部皮瓣等简单方法进行修复,受区有可用于吻合的血管。排除标准:原发性或继发性血管病变,全身情况不耐受长时间手术。根据患者意愿分组,采用背阔肌肌皮瓣或肩胛皮瓣进行修复,即传统皮瓣组;采用背阔肌肌瓣填充、覆盖创面,再用中厚或全厚皮片游离移植封闭肌瓣表面的方法进行修复,即联合移植组。术后主要对足部功能、是否正常穿鞋、皮瓣外形、二次手术等情况进行随访。结果共41例患者纳入本研究,所有皮瓣均存活,无感染和皮肤坏死。传统皮瓣组23例,男性16例,女性7例,年龄6~52岁,平均年龄27.6岁。缺损面积为5.5 cm×8.0 cm^19.5 cm×23.0 cm,平均10.1 cm×16.2 cm。术后定期随访6~24个月,平均9.7个月。足部行走功能基本恢复,皮瓣质地良好,其中18例患者认为皮瓣外形较为臃肿,其中15例影响穿鞋,14例进行了皮瓣去脂手术,2例瘢痕较明显。联合移植组18例,男性14例,女性4例,年龄19~49岁,平均30.7岁。缺损面积为4.0 cm×6.5 cm^20.5 cm×23.0 cm,平均11.7 cm×17.3 cm。术后随访4~20个月,平均8.3个月。所有患足行走功能基本恢复,足部外形良好,不臃肿,轮廓与足踝部曲线与健侧相近,无皮肤损伤和溃疡发生,全部患者穿鞋满意,无需二次手术,9例瘢痕较明显。结论与传统背部游离皮瓣相比,在恢复足部功能的基础上,游离背阔肌肌瓣联合表面植皮术可有效覆盖较大面积的足背软组织缺损,术后不臃肿,无需二次手术修整皮瓣,外观更为满意,但联合移植组术后瘢痕增生的风险加大。
Objective To compare the results of thinned latissimus dorsi muscle flap combined with skin grafting and dorsal free flaps in repairing traumatic dorsal foot defects.Methods From January 2005 to December 2019,41 patients with large soft tissue defects in the dorsum of the foot were admitted to our department.Inclusion criteria:unilateral dorsal foot and ankle soft tissue defects,accompanied by tendon and/or bone exposure,cannot be repaired by simple methods such as skin grafting and local flaps,and the affected area has blood vessels that can be used for anastomosis.Exclusion criteria:primary or secondary vascular diseases,systemic conditions intolerant to prolonged surgery.According to the patient’s choices,the latissimus dorsi flap or the scapular flap were used for repair,namely the traditional flap group.Or latissimus dorsi muscle flap was used to fill and cover the defect,and then the surface of the muscle flap was sealed with split-thickness or full-thickness skin grafting,which is the combined transplantation group.Postoperative follow-up was mainly focused on the recovery of foot function,whether the shoes were worn normally,the appearance of the flap,and the rate of second operation.Results A total of 41 patients were included in this study.All the flaps survived without infection and tissue necrosis.Twenty three cases,16 males and 7 females,age from 6 to 52 years with an average of 27.6 years,were repaired with latissimus dorsi flap or scapula flap.The area of soft tissue defects was from 5.5 cm×8.0 cm to 19.5 cm×23.0 cm,with an average areaof 10.1 cm×16.2 cm.The follow-up time was from 6 to 24 months with an average of 9.7 months.All walking function of the foot was basically restored,and the texture of the flap was good.Eighteen patients had bloated flap appearance,15 of which affected shoe-wearing,and 14 had debulking surgery,2 had developed hypertrophic scar.Eighteen cases,14 males and 4 females,age from 19 to 49 years with an average of 30.7 years,were repaired with latissimus dorsimuscle flap combined with split-thickness or full-thickness skin grafts.The area of soft tissue defects was from 4.0 cm×6.5 cm to 20.5 cm×23.0 cm,and the average area was 11.7 cm×17.3 cm.All donor-site incisions are sutured in one stage without skin grafting.The follow-up time was from 4 to 20 months with an average of 8.3 months.The walking function of all operative feet,with good shape and without bloating,was basically restored.The contour and curve was similar to the healthy side and no skin injury and ulcer was observed.All patients were satisfied with wearing shoes and walking function,and no secondary surgery was required.However,9 patients had developed hypertrophic scar.Conclusions Compared with the traditional flap,the free latissimus dorsi muscle flap combined with skin grafting can effectively cover large area of soft tissue defect on the dorsal foot,without bloated flap appearance and secondary surgery.However,the risk of scar hyperplasia after combined transplantation increased.
作者
韩愚弟
韩岩
郭伶俐
陶然
李亮星
牛泽浩
周志强
Han Yudi;Han Yan;Guo Lingli;Tao Ran;Li Liangxing;Niu Zehao;Zhou Zhiqiang(Department of Plastic and Reconstructive Surgery,First Medical Center of PLA General Hospital,Beijing 100853,China;Department of Burn and Plastic Surgery,Seventh Medical Center of PLA General Hospital,Beijing 100010,China)
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2020年第6期638-644,共7页
Chinese Journal of Plastic Surgery
关键词
游离皮瓣
足创伤
显微外科
软组织创伤
Free tissue flap
Foot injuries
Microsurgery
Soft tissue injuries
