皮瓣转移或移植修复小腿皮肤缺损

Repair of leg skin defect with flap transfer or transplantation

目的:探讨小腿部皮肤缺损显微外科修复的方法。方法:采用小腿内侧、外侧、前外侧肌间隙血管蒂皮瓣、腓肠肌皮瓣局部转移,股前外侧皮瓣、胸脐皮瓣、背阔肌皮瓣等移植修复小腿皮肤缺损,对合并骨缺损者采用小腿外侧骨皮瓣、肩胛骨皮瓣移植、髂骨皮瓣或骨瓣与皮瓣组合移植修复,根据受区的血管损伤情况设计四种血液循环重建方法。结果:本组临床应用97例,33例带血管蒂皮瓣转移全部成活,64例游离皮瓣移植中7例术后出现血液循环危象,经探查4例成活,3例失败。结论:皮瓣转移或移植是修复小腿部皮肤缺损的良好方法,但应根据创面修复原则及不同的伤情选择治疗方法。

Objective: To investigate the selection of flap and treatment method of repairing leg skin defect by microsurgery technique. Methods:Leg skin defect was repaired by regional transfer of medial, lateral, anterolateral, gastrocnemius vascular pedicle leg flap and free transplantation of revascularized anterolateral thigh flap, paraumbilical flap, latissimus dorsi flap. For the treatment of those combined with bone defect, compound tissue transplantation was used, such as lateral leg bone flap, scapular bone flap, iliac bone flap or combined transplantation of bone and skin flap. Four methods of circulation reconstruction were designed based on the condition of blood vessel injury in recipient region. Results: There were 97 cases in this study, all 33 with regional transfer of flap were successful. Circulation crisis occurred in 7 cases among 64 cases repaired with free flaps; 4 flaps survived and 3 failed. Conclusion: The regional transfer and free transplantation of flap are satistactory treatment methods to repair leg skin defect, but the selection of repairing methods is very important, and it should be based on the condition of injury and repairing principles.