应用交腿皮瓣修复足踝关节严重损伤

Cross Leg Skin Flaps Were Applied to Repairing the Severe Injury of Foot and Ankle

目的 观察应用交腿腓肠肌肌皮瓣修复足、踝关节严重损伤的效果。方法 选取 2 0 0 2年 8月— 2 0 0 3年 11月我院 5例足严重损伤病人 ,均为男性 ,年龄 2 6～ 47岁。高压电伤 1例 ,为接触 3 5万V高压电致伤 ;热压伤 3例 ;重物砸伤 1例。设计对侧小腿腓肠肌内侧头肌皮瓣 ,皮瓣基部位于小腿后上方 ,后缘位于小腿后正中线 ,前缘位于大隐静脉内侧 ,皮瓣大小为 3 0cm× 11 5cm～ 18cm× 7cm。保护小隐静脉及腓肠神经 ,找到腓肠动脉进入腓肠肌的点 ,并分出腓肠肌外侧皮瓣的营养动脉 ,加以保护 ,切取皮瓣。行创面清创 ,尽量清除坏死组织 ,保留间生态组织 ,对于大血管周围坏死组织可予以适当保留 ,以过氧化氢溶液及 0 1%苯扎溴铵溶液反复清洗创面 ,彻底止血 ,将皮瓣移植缝合于创面 ,皮瓣下放置橡皮引流条 ,双下肢行石膏托固定。结果 所作 5个腓肠肌内侧头肌皮瓣及 1个腓肠肌外侧头肌皮瓣均顺利成活 ,创面修复满意。结论 腓肠肌肌皮瓣作为交腿应用具有可供切取的皮瓣面积大 ,应用灵活、有足够长的蒂 ,可再利用、抗感染能力强、容易固定、操作简便 ,成功率高。

Objective To study the effect of cross leg skin flap on the repair of severe injury of foot and ankle. Methods Five male patients with severe foot injury, aging from 26 to 47 years old, were enrolled. Two ones were injured respectively by high voltage and by heavy pound, and three by hot crush. The myocutaneous flaps of medial head of contralateral gastrocnemius were designed between 30 cm×11.5cm and 18 cm×7 cm under the condition of careful protection of involved blood vessels and nerves, and then removed and sutured onto the wound surfaces that had been performed debridement. Drainage from beneath the transplanted flaps was placed, and the bilateral lower limbs were both fixed with plaster splints. Results Five myocutaneous flaps of gastrocnemius medial head and one flap of lateral head survived successfully, so the repair of the wounds was satisfying.Conclusion Being cross leg skin flap, gastrocnemius myocutaneous flap possesses such advantages as large area, long pedicle, flexible application, high success rate, and so on.