摘要
目的研究胫骨大范围裸露修复的最佳方法。方法对322例患者,采用游离皮瓣移植术对侧胫后血管皮支为蒂的皮瓣逆行移转术、对侧胫后血管桥接游离皮瓣移植术修复。结果 322例胫骨裸露范围为12cm×3cm～24.0cm×3.5cm,用皮(肌)瓣覆盖胫骨均获成活,皮瓣与创缘有300例Ⅰ期愈合,22例延期愈合。随访1～5年,下肢功能均改善。无一例因胫骨失去皮肤覆盖而截肢,患者满意。结论带部分腹直肌的胸脐皮瓣、带部分肌肉的阔筋膜皮瓣、肩胛侧胸联合皮瓣游离移植是修复胫骨大范围裸露的良好方法。
Objective To study the best method in repairing the defect with a large area of bare tibia. Method Three hundred and twenty-two cases of large bare tibia defects were treated by three mi- crosurgical methods. Results The bare tibiae in the 322 cases ranging from 12 × 3cm to 24.0 × 3.5cm were covered with myocutaneous flaps. Primary wound healing was achieved in 300 cases and delayed healing in 22 cases, All the cases were followed-up for 1 to 5 years. The function of the lower limbs was evidently improved. None of them was amputated due to deficit of skin coverage. The patients were all satisfied with the operative results. Conclusion Transposition of the bridging skin flap pedicaled with the contralateral posterior tibial blood vessels can cover extensive bare tibia to avoid amputation. Other myocutaneous flaps from thoraco-umbilical, tensor muscle of fascia lata and scapular-lateral chest areas are good options too.
