中前足骨与软组织缺损的一期显微重建

One-stage bone and soft tissue reconstruction for complex defects at the midfoot and forefoot

目的探讨中前足骨与软组织缺损一期显微重建的新方法。方法对2009年1月至2014年1月分别以旋髂浅动脉蒂髂骨骨皮瓣或以股前外侧皮瓣血流桥接髂骨骨皮瓣、骨瓣重建的12例中前足复合缺损患者资料进行回顾性分析，男9例，女3例；年龄17～58岁，平均41．2岁；创面面积16cm×3cm～20cm×16cm。术后采用临床及放射学方法评估功能恢复情况。结果切取髂骨骨皮瓣11例，髂骨瓣1例，其中骨瓣体积4cm×1cm×1cm-8cm×2cm×1cm，皮瓣面积5cm×3cm-18cm×6cm。8例以股前外侧皮瓣为血流桥接皮瓣，皮瓣体积10cm×5cm～25cm×11cm。所有患者术后随访12～24个月，平均18．5个月，均获得骨愈合，骨愈合时间平均为3．8个月，完全负重时间平均为6．2个月。美国足踝外科协会的中足评分平均为73．7分，外观满意度评分平均为6．4分。结论旋髂浅动脉蒂的髂骨骨皮瓣是重建中前足复合缺损的一种可选择的方法。与股前外侧皮瓣组合使用，能有效覆盖广泛的软组织缺损。

Objective To explore a new method to reconstruct the complex tissue defects at the midfoot and forefoot. Methods From January of 2009 to January of 2014, the complex tissue defects at the midfoot and forefoot in 12 patients were reconstructed with iliac osteocutaneous flap based on the superficial circumflex iliac artery which was bridged with or without anterolateral thigh flap. The patients were 9 males and 3 females, from 17 to 58 years of age （average, 41.2 years）. The defective areas ranged from 16 cm × 3 cm to 20 cm × 16 cm. Their functional recovery was evaluated clinically and radiologically. Results Eleven iliae osteocutaneous flaps and one iliac osseous flap were harvested. The sizes of the iliac bone segment ranged from4cm×1cm× 1cm to 8cm ×2cm × 1 cm; the sizes of the skin paddle ranged from5 cm × 3 cm to 18cm × 6 cm. Eight cases were treated with a combination with the anteriolateral thigh flap which ranged from 10 cm × 5 cm to 25 cm × 11 cm. The follow-up periods ranged from 12 to 24 months, averaging 18.5 months. Bone union was observed in all cases, with an average period of 3.8 months. Full weight bearing status was achieved after an average period of 6.2 months. The average American Orthopaedic Foot and Ankle Society score was 73.7 points; the average aesthetic satisfaction score was 6. 4 points. Conclusions Iliac osteocutaneous flap based on the superficial circumflex iliae artery is a new valuable alternative for reconstruction of complex tissue defects at the midfoot and forefoot. In cases of extensive soft tissue defects, a combination with the anterolateral thigh flap may allow better orientation and coverage.