股前外侧皮瓣串联腓骨皮瓣修复小腿大面积皮肤软组织伴骨缺损

Transplantation of anterolateral thigh flap connected with the fibular flap for repair of massive soft tissue and bone defects at the leg

目的 探讨吻合血管的股前外侧皮瓣串联腓骨皮瓣修复小腿大面积皮肤软组织伴骨缺损的临床效果。方法2005年6月至2008年7月，将股前外侧皮瓣与腓骨皮瓣的轴心血管串联吻合后移植修复8例小腿大面积皮肤软组织伴大段胫骨缺损患者。皮肤软组织缺损面积为23cm×12cm。34cm×16cm，骨缺损长度为7—16cm。股前外侧皮瓣切取面积为16cm×12cm～28cm×15cm，腓骨皮瓣切取面积为15cm×6cm～21cm×10cm，腓骨切取长度为10～18cm。结果7例串联组织瓣一期成活，1例术后皮瓣远端边缘坏死，经换药伤口逐渐愈合。8例患者术后获7～31个月（平均16个月）随访。3～6个月移植腓骨愈合，术后1年移植腓骨直径明显增粗。所有皮瓣质地柔软，形态及功能满意，供区无功能障碍。结论应用股前外侧皮瓣串联腓骨皮瓣联合移植能有效修复小腿大面积皮肤软组织伴骨缺损，且缩短了病程，减少了肢体的伤残率。

Objective To explore the transplantation of vascularized anterolateral thigh flap connected with fibular flap for repair of massive soft tissue and bone defects at the leg. Methods The massive soft tissue and bone defects at the leg were reconstructed with vaseularized anterolateral thigh flap connected with the fibular flap in 8 patients. The areas of soft tissue defect ranged from 23 cm × 12 cm to 34 cm × 16 cm, and the bone defects ranged from 7 cm to 16 cm. The area of anterolateral thigh flap ranged from 16 cm× 12 cm to 28 cm × 15 cm, the areas of fibular osteocutaneous flap ranged from 15 cm × 6 cm to 21 cm × 10 cm, and the lengths of fibular graft were 10 cm to 18 em. Results They were followed up for an average of 16 （7 to 31） months. The connected flaps survived at the first stage in 7 eases and margin necrosis occurred in 1 case which responded gradually to dressing change. The fibular graft united 3 to 6 months postoperatively. The diameter of the fibular graft increased obviously after 1 year. The appearance of the flaps and the function of the limb were satisfactory without any functional impairment at the donor site. Conclusion Transplantation of the anterolateral thigh flap connected with the fibular flap is an effective method for repair of massive soft tissue and bone defects at the leg, because it can shorten the time of therapy and decrease the rate of disability.