游离前锯肌肌瓣桥式移植修复踝部软组织缺损

Repair of Soft Tissue Defect in Ankle with Free Serratus Anterior Muscle Flap by Bridge Transplantation

目的总结游离前锯肌肌瓣桥式移植修复踝部软组织缺损的临床效果。方法应用游离前锯肌肌瓣桥式移植修复5例小腿软组织缺损。制备肌瓣及肩胛下旋肩胛血管,使血管蒂呈"T"形,与健侧小腿胫后动脉两断端行端端吻合,肌瓣和血管蒂用中厚网状游离皮片覆盖。结果肌瓣全部成活,术后恢复良好,效果满意。随访8个月至4年,未发现明显的供区功能障碍。供区与受区外形较好,健侧小腿经临床观察与多普勒检查,胫后动脉通畅。结论本方法适合修复小腿软组织缺损;对于仅有1条主要动脉保留者,不损伤健侧小腿胫后动脉,降低了对供区的损伤。

Objective To investigate the operative method of soft tissue defect of ankle with free serratus anterior muscle flap by bridge transplantation and its clinical effect.Methods Five patients with soft tissue defect of the ankl were reconstructed with free serratus anterior muscle flap by bridge transplantation.The serratus anterior muscle flap was elevated with subscapular and circumflex scapular vessels forming a ＂T＂ shaped vascular pedicle.The ＂T＂ shaped vascular pedicle was anastomosed to the two vascular ends of the posterior tibial artery of contralateral leg by end-to-end anastomosis.Immediate coverage of the serratus anterior muscle flap and its vascular pedicle were performed by a meshed split-thickness skin graft.Results The serratus anterior muscle flap had survived completely without major complications and got satisfactory clinical results.Follow-up period was ranged from 9 months to 3.6 years postoperatively.There was no remarkable morbidity at donor site.All cases had good appearance both in recipient and donor site.The patency of the posterior tibial artery of contralateral legs were demonstrated by clinical examination and Doppler examination.Conclusion This technique is particularly useful in leg reconstruction surgery when only one vessel remains.The patency of the posterior tibial artery of contralateral legs is preserved and damage to donor site is reduced.