改良筋膜皮瓣修复创面系列手术在创伤骨科的应用

Application on the operations of repairing wound with improved fasciocutaneous flap in orthopedic trauma

目的 总结改良筋膜皮瓣系列手术应用于修复创伤性难治性创面的临床效果.方法 通过对Z成形筋膜皮瓣、前臂桡侧逆行筋膜皮瓣、小腿内侧逆行筋膜皮瓣的形状和结构的成形方法及移位方式的改良,扩大了皮瓣可供面积,加快皮瓣血运重建.结果 本组93例,一例远位交腿皮瓣因人为因素导致移植失败,2例皮瓣下感染致部分皮瓣坏死,其余皮瓣成活,全部创面修复,远位移植皮瓣断蒂时间为术后5～15天,平均12天,随访时间6个月～5年,皮瓣质地柔软,色泽似供皮瓣组织,大部分皮毛与原供皮瓣部位一致,部分皮毛表现细长且黑,皮瓣不臃肿,无压疮或溃烂,无带感觉皮瓣或远位移植皮瓣断蒂后约一年感觉基本恢复.结论 改良传统筋膜皮瓣可供面积大,皮瓣转位灵活,修复范围广,断蒂时间早、缩短疗程,皮瓣质量好、能有效修复临床上难治性创面.

Objective To summarize the clinical effects of the operations series about repairing refractory and traumatic wound with improved fasciocutaneous flap. Methods By imprving the form of the shape and structure and the shift mode of Z shaped fasciocutaneous flap, retrograde radial forearm fasciocutaneous flap, retrograde medial leg fasciocutaneous flap, it expanded the area supplied by the flap, and accelerated the flap revascularization. Results In this group there were 93 patients, 1 patient with distal cross-leg flap caused a graft failure due to human factors, 2 patients caused partial flap necrosis because of infection under the skin flap. The remaining flaps all survived and the wound was healed. The pedicle time of distant skin flap was 5-15 days after operation, an average of 12 days, the follow-up time was 6 months to 5 years, the flap was soft, its color was the same as the original, most of the skin was like the original, part of skin was slender and black, not swollen, without pressure sores or ulcers. The skin flap without feeling or distant flap recover skin flap feeling after about a year. Conclusion hnproving traditional fasciocutaneous flap can expand the area supplied by the flap, with flexible shifts, can repair a wide range, reduce the time of pedicle flap, shorten the course of treatment, keep good quality, and can effectively improve the clinical repair of refractory wound.