桥式交叉联合游离背阔肌肌皮瓣及游离腓骨修复小腿复合组织缺损

陈宏，王欣，徐吉海等.桥式交叉联合游离背阔肌肌皮瓣及游离腓骨修复小腿复合组织缺损[J].中华创伤杂志.2013, 29(3):262-266.

下肢,游离组织移植物,胫骨骨折,腓骨，动静脉吻合

陈宏，王欣，徐吉海，李学渊，章伟文

315040,宁波市第六医院手外科

2013

262-266

2,万方

目的 介绍运用桥式交叉联合游离肌皮瓣和游离腓骨治疗临床常见的严重小腿复合组织缺损手术修复方法,评价其临床应用的可行性. 方法 选择2008年5月-2012年5月收治的12例小腿胫骨缺损伴软组织缺损患者,胫骨缺损均超过8 cm(9～ 12 cm),软组织缺损面积17 cm×12cm～20cm×18 cm.用桥式交叉联合背阔肌肌皮瓣及游离腓骨Ⅰ期修复,肩胛下动静脉为血管蒂与健侧小腿胫后动静脉端端吻合,胸背动脉远端分支前锯肌支为蒂与腓骨瓣的腓动静脉吻合.术后外固定支架固定双侧小腿. 结果 所有患者得到随访,随访时间13～32个月,平均21个月.参照Enneking系统,12例患者游离背阔肌、游离腓骨串联移植后肢体平均功能评分23分,肢体功能恢复77％. 结论 桥式交叉联合背阔肌肌皮瓣及游离腓骨皮瓣解决了受区血管条件有限的问题,是重建小腿大面积复合缺损的有效方法之一. Objective To introduce surgical repair methods of cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula for complex lower leg defect and discuss its clinical feasibility.Methods The study included 12 patients with tibial defect larger than 8 cm (range,9-12 cm) combined with soft tissue defect of 17 cm × 12 cm to 20 cm × 18 cm treated from May 2008 to May 2012.Cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula was performed at the first phase.The flap pedicled with subscapular vessel was anastomosed to posterior tibial artery and vein of normal lower leg.The flap pedicled with anterior serratus muscle of distal thoracodorsal artery was anastomosed to peroneal vessel of fibular flap.External fixators were used to immobilize the bilateral lower legs postoperatively.Results All patients were followed up for 13-32 months (mean 21 months).According to Enneking system,mean leg function was scored 23 points after tandem transplantation of free latissimus dorsi muscle and free fibula,with recovery rate of 77％.Conclusions Cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula tackles the problem of recipient vessel limitation.Further,the technique is effective in repair of large area of complex defect in lower legs.