旋髂深动脉供应的髂骨穿支皮瓣设计与应用

Vascularized lilac osteocutaneons perforator flap based on the deep circumflex lilac artery： operative design and clinical applications

目的探讨旋髂深动脉供应的髂骨穿支皮瓣的临床应用效果。方法根据旋髂深动脉的走行和分支特点，设计旋髂深动脉供应的髂骨穿支皮瓣，使切取后的骨瓣与穿支皮瓣两者完全分离。2003年2月至2005年12月，对5例四肢长骨干合并软组织缺损者进行修复，均为男性；年龄23～57岁，平均36．5岁。其中前臂软组织伴尺骨缺损1例，小腿中下段软组织伴胫骨缺损4例，均为Gustilom型骨折。切取的皮瓣面积5cm×8cm-10cm×18cm；髂骨瓣长度为6-10cm。结果5例切取的旋髂深动脉供应的髂骨穿支皮瓣中骨瓣与皮瓣完全分离，两者之间具有很大的移动度。5例中1例皮瓣部分坏死，术后4周局部行带蒂皮瓣修复而痊愈，另4例全部成活。随访4-18个月，四肢骨缺损完全愈合，骨愈合时间4-7个月，平均5．5个月。皮瓣外观和功能良好。结论髂骨穿支皮瓣两者共用一个血管蒂，皮瓣与骨瓣之间有更大的移动度，属于嵌合皮瓣中的一类，适合修复四肢骨与软组织复合缺损时两者方位不一致的患者。

Objective To modify the harvest method of traditional iliac osteocutaneous perforator flap and separate the skin flap from the bone flap, and discuss the clinical effect. Methods According to local applied anatomy of groin, vascularized iliac osteocutaneous perforator flap based on the deep circumflex iliac vessels was designed and applied. From February 2003 to December 2005, 5 patients who had traumatic open extremity fractures and combined bone and composite soft-tissue defects were treated with vascularized iliac osteocutaneous perforator flap transplantation based on the deep circumflex iliac vessels. All patients were males, with the mean age of 36.5 years （ranged from 23 to 57 years）, and suffered Gustilo Ⅲ fracture. The size of perforator flap ranged from 5 cm×8 cm to 10 cm×18 cm, the length of iliac bone graft was 6-10 cm. Results Vascularized iliac osteocutaneous perforator flaps based on the deep circumflex iliac vessels were successfully harvested in 5 cases, and there was considerately motive scope between iliac bone flap and cutaneous flap. The partial skin flap necrosis was encountered in only 1 case, which received pedical flap in postoperative 4 weeks. The other iliac osteocutaneous perforator flaps were fully survival. After 4- 18 months postoperative follow-up, all the bone defect gained healing, the average time of healing was 5.5 months （4-7 months）. The function and appearance of cutaneous flaps were satisfactory. There was no serious complication in donor sites of groin. Conclusion Vascularized iliac bone graft and a perforator flap are nourished by the same deep circumflex iliac vessels, there is more mobile scope between the bone graft and skin flap, which should be called the chimerical flaps, and is favor of clinical application of composite tissue graft and minimizes the donor site complication.