组织瓣移植结合骨搬运修复重建小腿大范围复合组织缺损

Tissue flap transplantation plus bone transportation for repair of massive multi-tissue defects at the leg

目的 探讨组织瓣移植结合骨搬运修复重建小腿大范围复合组织缺损（大面积软组织缺损合并大段骨缺损）的临床疗效.方法 回顾性分析2005年1月至2011年12月收治的92例小腿大范围复合组织缺损患者的临床资料,男71例,女21例;年龄19 ～56岁,平均38.3岁.所有患者术前均采用中医外敷法湿敷创面;后行亚急症皮瓣移植结合骨搬运治疗小腿大范围皮肤缺损合并大段骨缺损,肌皮瓣移植结合骨搬运重建毁损的肌肉功能并修复大段骨缺损;组织瓣移植术后,再采用水蛭地龙汤抗凝.结果 92例患者手术实施成功率达100％,无一例患者发生感染,吻合血管游离移植106块组织,除1例患者皮瓣远端部分干性坏死外,其他移植组织全部成活;手术次数平均为2.6次,骨愈合时间平均为256 d.92例患者术后获10 ～ 48个月（平均24.6个月）随访,按照国际Paley等的标准评定功能：优53例,良26例,可9例,差4例,优良率达85.9％.结论 对于小腿大范围复合组织缺损,组织瓣移植结合骨搬运可以最大限度地恢复患肢的功能,是一种较好的修复重建的方法.

Objective To report the clinical effects of treating massive multi-tissue defects at the leg with tissue flap transportation and bone transportation.Methods The clinical data was analyzed retrospectively of 92 patients who had been treated from January 2005 to December 2011 for massive soft tissue and large segmental bone defects at the leg.They were 71 males and 21 females,with a mean age of 38.3 years （range,19 to 56 years）.They were treated by herbal dressing on wounds before operation.At the subacute stage,massive skin and large segmental bone defects were treated with skin flap transplantation plus bone transportation and damaged muscular function and large segmental bone defects were managed with musculocutaneous flap transplantation plus bone transportation.After operation,traditional Chinese medication was administered for anticoagulation in all cases.Results All operations were completed successfully without infection.Vascular anastomoses were conducted in free transplantation of 106 pieces of tissue.All transplanted tissues survived except for tip necrosis of one skin flap.On average,each patient received 2.6 operations and had an average duration of 256 days for treatment.The follow-up periods for all the patients ranged from 10 to 48 months （mean,24.6 months）.According to Paley criteria,53 cases were rated as excellent,26 as good,9 as fair,and 4 as poor,giving a good to excellent rate of 85.9%.Conclusion As tissue flap transplantation plus bone transportation can restore the function of the leg as much as possible,it is an effective treatment of massive multi-tissue defects at the leg.