小腿内侧逆行皮支皮瓣交腿应用的体会

Experience of cross application of retrograde crural medial flap with cutaneous branch

目的探讨小腿内侧逆行穿支皮瓣在临床上交腿应用的修复效果及经验。方法自2009-01—2013-12,4例小腿远端胫腓骨骨折内固定术后断端、胫前肌腱和内固定物缺少皮肤软组织覆盖,一期行交腿皮瓣修复;10例行骨折固定手术或清创术后出现皮肤软组织坏死,再次清创后创面内骨、肌腱、内固定物外露,二期交腿皮瓣修复;3例小腿、足踝部外伤在非手术治疗过程出现皮肤坏死,清创后骨、肌腱外露,后采用交腿皮瓣修复治疗。结果本组17例均获得平均8.2（6～12）个月随访。16例皮瓣断蒂后成活良好。1例皮瓣断蒂后缝合创面蒂部皮瓣封闭创面,3 d后皮瓣出现红肿,将封闭创面敞开引流,之后皮瓣红肿消退,逐渐愈合。14例皮瓣愈合后外观良好,3例为改善皮瓣臃肿外观后期行皮瓣修整术。结论小腿内侧逆行穿支皮瓣在交腿应用时,皮瓣切取操作更简单,供区损伤更小,临床修复效果良好,适用于修复小腿、足踝部皮肤缺损。

Objective To investigate the experience and clinical effect of cross application of retrograde crural medial flap with cutaneous branch. Methods From January 2009 to December 2013, 4 patients did not have available skin to cover tibia and tendon and internal fixation after lower leg fracture surgery, the defect was repaired by the cross application of retrograde crural medial flap with cutaneous branch one-stage. There were 8 patients with skin and soft tissue necrosis after fracture surgery or debridement, the defect after resected necrotic tissue was repaired by cross flap two-stage. During non-operative treatment, 3 patients＇ defect in lower leg after resected necrotic tissue was also repaired by cross flap. Results All the patients were followed up for 6 to 12 months（averagely 8.2 months）. In these patients, in 16 cases the flaps well survived, in 1case the flap appeared red and swollen in the third day after the flap＇s pediclewas cut off, after the suture line was partly cut off and drain was conducted underneath the flap, the flap turned normal gradually. In 14 cases the flap＇s appearance was good, in 3 cases the flap was fat and received secondary plastic surgery. Conclusion The cross application of retrograde crural medial flap with cutaneous branch is easier to peform with less damage to the donor site and clinical repair effect. It especially apply to repairing the skin and soft tissue defects of the lower leg, ankle and heel.