组织瓣在四肢创伤修复中的应用

APPLICATION OF TISSUE FLAPS IN REPAIR OF LIMBS INJURIES

目的 回顾总结带血管蒂皮瓣、复合组织瓣在四肢创伤性组织缺损修复中的应用经验。方法 1991年 10月～ 2 0 0 0年 12月 ,采用 14种皮瓣及复合组织瓣对 6 7例四肢创伤性组织缺损分别采用吻合血管的游离移植及局部带蒂移位或交叉转移进行修复。结果 游离移植成活 4 0例 ,带蒂移位成活 2 6例 ;伤肢功能及外形满意 5 3例 ;骨瓣及骨皮瓣全部愈合 ;吻合神经的肌皮瓣均恢复 2～ 3级肌力。结论 应用带血管蒂皮瓣、复合组织瓣修复四肢创伤性组织缺损时 ,应注意根据缺损的部位、大小、层次或深浅等情况选择不同的组织瓣及移植方法进行修复 ,正确的手术操作和术后处理以提高修复效果。

Objective To summarize and analyze the main point on the reconstruction of traumatic tissue defects of limbs with vascularized skin and multi tissue flaps. Methods Sixty seven cases of traumatic tissue defects of limbs were reconstructed with 14 kinds of skin or multi tissue flaps. The operative methods included local transposition, cross transposition with vessel pedicles and vessel anastomosed free transplantation. Results Forty cases with vessel anastomosed free transplantation and 26 cases with local or cross transposition of vessel pedicled flaps were survived. In the followed up cases, 53 cases were satisfied with the outward appearance of the skin flaps. All the cases with bone flap or skin bone flap resulted in union. And the cases with motor nerve anastomosed myocutaneous flap transplantation had recovered to 2-3 grade muscle contraction ability. Conclusion It is important that the appropriate flaps and operative methods should be chosen according to the size, location, depth and structure of the tissue defects. To raise the success rate and to gain better operation effect, the correct manipulation in operation and the rational postoperative treatment are necessary.