摘要
目的 解决小腿创伤后胫前或胫后主要血管之一长段受损栓塞,同时小腿中上段大面积软组织缺损、胫骨外露的创面修复问题。方法 临床收治15例小腿中上段大面积软组织缺损,胫骨外露病人,其中11例有胫前或胫后血管长段受损栓塞。采取以小腿远端胫前或胫后血管远端与腹壁下血管吻合的胸脐皮瓣移植修复创面。结果 15例病人移植皮瓣全部成活,皮瓣色泽、质地良好,创面完全修复。结论 只要小腿胫前或胫后主要血管之一正常,受损血管远端正常,逆行供血良好,即可采用本法。其优点为在小腿清创的同时解剖出受区血管,不影响患肢血供,不需牺牲健肢血管,不需强迫体位固定;在小腿下段肌肉少,血管位置浅,容易解剖,吻合血管方便;修复小腿中上段创面,移植皮瓣血管蒂平直,不需翻转成角。
Objective To resolve the large area skin defects with bone exposure in the leg with long distance thrombosis of the anterior tibial vessels or the posterior tibial vessels due to posttraumatic lesion. Methods 15 cases who had large area skin defects with bone exposure in the proximal middle segment of leg were admitted to our hospital. 11 cases of them had long distance thrombosis of the anterior tiial vessels or posterior tibial vessels due to posttraumatic lesion. In the treatment, thoracoumbilical flap, based on the inferior epigastric vessels, was anastomosed to the distal stump of the anterior tibial vessels or posterior tibial vessels with reversed flow. Results All of them were successfully repaired. The color and texture match of the flaps were good. Conclusion If one of them that the anterior tibial vessels or posterior tibial vessels is normal, distal stump of injured boold vessels normal and reversed flow being good, this technique can be used. The method had the advantages of dissecting of blood vessels of recipient area while cleaning foci, not affecting blood circulation of the injured leg, not sacrificing blood vessels of the opposite leg, not being fixed at forced posture. The muscles are less in the distal one - third of leg, and the blood vessels which are dissected and anastomosed easily are shallow. When flap is used for reconstruction in the proximal two - thirds, the base of blood vessels of free flap is in straight angle, not acute angle.
