游离小腿内侧皮瓣修复小儿肢体高能量损伤的特殊意义及相关问题探讨

Medial leg flap containing posterior tibial vessels for reconstructio n in children's limb injuries by high-energy

[目的]研讨游离小腿内侧皮瓣对修复合并皮肤软组织缺损的小儿肢体高能量损伤的特殊运用价值及意义。[方法]1999年1月～2006年3月对10例合并软组织缺损的小儿高能量严重肢体损伤运用吻合血管的小腿内侧皮瓣修复，并对术式特点、疗效进行分析。[结果]水中平均出血量183ml，平均手术时间208min，皮瓣全部成活。随访时间14～67个月，平均35个月。外观、皮肤质地满意、感觉恢复均达S3级以上，足负重区修复者恢复正常步态，无溃疡发生，骨折愈合时间4～9个月，平均6．7个月。通过调查表填写、临床观察未发现供肢循环障碍。[结论]小腿内侧皮瓣可在止血带下快速切取，对小儿全身干扰小，该皮瓣含全套深浅血管、皮神经，可用于桥接重建循环，感觉修复方便，适用于各种复杂情况下的小儿肢体严重损伤修复。

[ Objective] To report the clinical results of free medical leg flap containing posterior tibial vessels （FMLFPTV） in repairing of serious limb trauma caused by high-energy in children and discuss the flap＇s unique superiorities. [ Method] From Jan. 1999 to Mar. 2006,FMLFPTV were obtained under tourniquet and applied in ten children suffered from serious limb and extremity injuries complicated by soft tissue defects, meanwhile, vessels and nerves were repaired with the flaps＇ corresponding tissues,moreover,broken bones and tendons were reconstructed. [ Result] Average blood loss was 183ml and mean operative time was 208 min. All flaps were transplanted successfully with excellent results including satisfactory limb appearance. Follow-up ranged 14 to 67 months （averaged 35 months）. Sensation has recovered to more than S3 in all cases. In those who were treated with this innervated flap to repair defects of weight-bearing area of sole, no sore or ulcer occurred and normal gait recovered. Bone union took 4 - 9 months （averaged 6.7 months）. Through investigation forms filled by parents and clinical examination, no blood supply problem or morbidity was discovered in donor limbs. [ Conclusion] FMLFPTV is easy to dissect under tourniquets with relative short operative time and less blood lost which especially benefits children. The flap is thin and has almost necessary related tissues for all reconstructive needs ,for example ,to bridge vessel and nerve defects ,and offer excellent results. It is an easy and reliable method.