桥式交叉游离股前外侧肌皮瓣移植修复小腿大面积软组织缺损

Cross-bridge with the anterolateral thigh muscle flap for reconstruction of large soft tissue defect of crus

目的观察桥式交叉游离股前外侧肌皮瓣移植修复小腿大面积软组织缺损的临床疗效。方法应用桥式交叉游离股前外侧肌皮瓣移植修复小腿严重创伤后大面积皮肤软组织缺损合并深部组织外露的患者8例。软组织缺损范围最小28cm×9cm,最大23cm×20cm。术后两下肢用单臂外固定支架固定于平行位,3周断蒂。结果皮瓣全部成活,无血管危象发生。有1例因皮瓣过大皮瓣远端尖部坏死,经换药后愈合。随访3～10个月(平均8个月),皮瓣质地柔软,外形满意,骨折6～7个月愈合。结论该方法特别适宜小腿因严重创伤后肢体仅残留有1根主干血管,局部带蒂皮瓣不能修复的巨大创面,必须应用游离皮瓣移植覆盖创面的患者。在修复患肢缺损同时把健肢损伤降低到最低限度。

Objective To observe the clinical efficacy of the cross - bridge with the anterolateral thigh muscle flap for reconstruction of large soft tissue defects of the lower leg. Methods 8 patients with severe leg trauma large area of skin and soft tissue defect and exposure of deep tissue were recoustructed with the cross - bridge with the anterolateral thigh muscle flap. The smallest range of soft tissue defect is 28 cm × 9 cm and maximum 23 cm × 20 cm. With one arm after the two lower limb exterual fixation in parallel position, and it was pedicle after 3 weeks. Results All flaps survived without vascular crisis happened. And 1 patient because of excessive distal flap tip necrosis healed after changing dressing. Follow - up 3 to lO months （ mean 8 months ）, skin soft, appearance satisfaction, fracture healing 6 - 7 months.Conclusion The method is particularly suitable for severe post -traumatic leg residual limb only have one main vessel, local pedicle flap can not fix the huge wound, must be applied free flap wound coverage of patients. Limb defects in the repair while the healthy limb injury re- duced to a minimum. Placed parallel to the position of both lower extremities after flaps help blood circulation to facilitate the early care and early functional training.