小儿胸脐皮瓣游离移植修复足踝部严重软组织缺损

The application of pediatric thoracic free flap graft to repair a serious foot and ankle soft tissue defects in the preliminary clinic

目的探讨小儿胸脐皮瓣游离移植修复足踝部严重软组织缺损的可行性和临床初步疗效。方法应用显微外科技术采用胸脐皮瓣游离移植修复小儿足踝部大面积软组织缺损合并肌腱、骨关节外露患儿50例。软组织缺损面积最小6cm×11cm,最大9cm×16cm;全部采用胸脐皮瓣移植修复,其中腹壁下动、静脉与胫前动、静脉吻合26例,腹壁下动、静脉与足背动、静脉吻合14例,腹壁下动、静脉与胫后动、静脉吻合10例。皮瓣面积最小7cm×12cm,最大10cm×17cm,皮瓣供区全部直接缝合。结果皮瓣全部成活,无血管危象发生。皮瓣供区与受区伤口愈合良好。术后随访3～30个月,皮瓣血运良好,颜色好,质地柔软,外形不臃肿,足踝功能恢复良好,患儿行走良好。结论应用胸脐皮瓣游离移植可良好修复儿童足踝部严重软组织缺损。

Objective To explore he feasibility and preliminary clinical efficacy of the pediatric thoracic free flap graft to repair a serious foot and ankle soft tissue defects. Methods During April 2005 to June 2008, we used umbilical chest skin graft to repair large areas of pediatric foot and ankle soft tissue defect with tendon, bone and joint exposed 50 children, the smallest area of soft tissue defect was 6 cm × 11 cm, the largest is 9 cm × 16 cm; the use of umbilical skin graft to repair chest, abdominal wall under the artery and vein with the anterior tibial artery and vein anastomosis in 26 cases, under the abdominal artery and vein with the dorsal artery and vein anastomosis 14 cases, under theabdominal artery and vein with the posterior tibial artery＇ and vein anastomosis in 10 cases, the smallest area of flap 7 cm × 12 cm, the largest 10 cm × 17 cm, for all skin closure. Resealts All the flaps survived without vascular crisis. Flap for the district by district and wound healed well. Follow-up 3 to 30 months, flap had good blood circulation, good color with soft texture, itsppearanee was not bloated, foot and ankle function recovered well ,patients could walk to school on foot. Conclusion Free flap application of thoracic transplantation can help repair the child of severe ankle soft tissue defects well.