摘要
目的探讨利用游离皮瓣联合腓骨移植I期修复第一跖骨全长缺损的治疗方法和临床效果。方法2003年1月至2009年12月，对足部胫侧跖骨缺损的9例患者，采用游离皮瓣联合腓骨移植I期修复第一跖骨全长缺损。其中亚急诊修复6例，择期修复3例。采用股前外侧皮瓣（ALTPE）联合腓骨移植修复7例，采用背阔肌皮瓣（TAPF）联合腓骨移植修复2例。术中根据健侧第一跖骨的长度游离患侧腓骨重建第一跖骨，游离皮瓣同时修复周围软组织缺损。受区游离组织采用组合移植的血管吻合方式：皮瓣动脉（旋股外侧动脉降支或胸背动脉）与受区的动脉吻合，皮瓣静脉（伴行静脉）与受区大隐静脉吻合，将腓动脉及伴行静脉串联在皮瓣的动、静脉分支上。结果术后8例顺利成活，1例术后发生皮瓣静脉危象，经探查，股前外侧皮瓣坏死，即改用背阔肌皮瓣覆盖创面，皮瓣成活。9例患者经6～36个月的随访，皮瓣无溃疡发生，移植之腓骨骨性愈合，行走无再次骨折发生。根据Maryland足功能评定标准：优6例，良2例，可1例。结论游离皮瓣联合腓骨同期修复第一跖骨缺损，减少了手术次数、缩短了疗程，修复后患足功能良好，是重建足负重区及周围软组织缺损的有效方法。
Objective To evaluate the clinical effects of free fibula and flap grafts on the repair of all the first metatarsal bone at one stage. Methods There were 9 cases with the first metatarsal bone defect from Janurary 2003 to December 2009 that treated with free vascularized fibular bone and fi＇ee vascularized flap at one stage. In which 6 cases reconstructed at the primary stage and 3 cases reconstructed at the second stage. Seven cases reconstructed by free vascularized fibular combined with ALTPF, two cases reconstructed by free vascular- izcd fibular cmnbined with TAPF. The free vascularized fibular and flap restored the first metatarsal bone and the soft tissue defects respectively. Vascular anastomosis was the artery of flap anastomosis with anterior tibial artery and the vein of the flap anastomosis with great sapbenous vein, the peroneal artery and accompany vein anasto- mosis with artery and vein of the flap. Results The grafted tissues survived smoothly in 8 cases, vein crisis happened in 1 case and the ALTPF necrosis after blood vessels expedition. So the TAPF was changed to cover the soft defect and survived smoothly. Followiy-up were done from 6 to 36 months in 9 cases. There were no ul- cer on flaps and no fracture again, the fibulas had been bone healing. Evaluated by Maryland standards, six ca- ses were excellent,two cases were fine,one case was good. Conclusion The fibula combined flap grafts pro- vide a relatively better aheruative to repair the first metatarsal bone compound tissue defects at one stage. In ad- dition, the procedure decreased frequency of operations and short the course of treatment. Sensory function re- construction of fibula flaps should be given full attention. As fine function of the reconstructed foot, it is a effec- tive method for reconstruction the burdened area of the foot.
出处
《中华显微外科杂志》
CSCD
北大核心
2013年第1期32-35,共4页
Chinese Journal of Microsurgery
关键词
足
第一跖骨组织瓣
腓骨移植
显微外科
Foot
First metatarsal bone tissues flap
Fibula graft
Microsurgery
