吻合血管的游离组织移植在四肢创伤急诊修复中的应用

Application of vascularized free tissue transplantation in emergency repair of traumatized limbs:report of 86 cases

目的报道应用吻合血管的游离组织移植急诊修复四肢创伤的效果。方法1988年4月至2004年8月,进行急诊游离组织移植86例,修复肢体54例,再造拇指32例。移植的组织包括背阔肌肌皮瓣、股前外侧皮瓣、小腿内侧皮瓣、足背皮瓣、足底内侧皮瓣、废弃肢体的复合组织块及(足母)趾皮甲瓣。手术在伤后1～5 d内进行。结果术后发生血管危象8例,均行血管探查手术,5例危象解除,3例失败。移植组织的成功率为96．5%(83/86)。随访1～16年,平均7．5年。修复的肢体均保留或恢复了有用的功能,再造拇指功能优良率为87．5%。结论急诊游离组织移植是实现创伤肢体急诊修复及拇指再造的有效方法。

Objective To report the outcome of emergency repair traumatized limbs by vascularized free tissue transplantation. Methods From April 1988 to August 2004, 86 patients, 58 men and 28 women, had undergone emergency vascularized free tissue transplantation to have their injured limbs repaired in 54 cases and the missing thumbs reconstructed in 32. The patients aged from 5 to 55 （mean 27. 9） years. The transplants included latissimus dorsi myocutaneous flap, anterolateral femoral skin flap, medial crural skin flaps, dorsal pedal flaps, medial plantar flap, composite tissue mass of the discarded limbs and big toe skinnail flap. The operations were performed 1 to 5 days after injuries. Results Postoperative vascular crises occurred in 8 cases and were all followed by exploration with successes in 5 cases while failure in 3. The total survival rate of the transplants was 96. 5% （83/86）. In this series all the patients were followed up for 1 to 16 years with a mean of 7. 5 years only to reveal satisfying functional recovery in all the repaired limbs and an excellent and good rate of 87. 5% in the reconstructed thumbs. Conclusion Emergency vascularized free tissue transplantation is an effective way to repair a traumatized limb and to reconstruct a traumatically missing thumb.