采用显微外科技术修复前足脱套伤12例报告

Application of microsurgical technique on repairment of forefeet degloving injury in 12 case report

目的介绍采用显微外科技术修复前足脱套伤的临床经验和疗效。方法 2012年9月~2013年12月,应用股前外侧穿支皮瓣修复前足脱套性损伤12例,其中男10例,女2例。致伤原因:车祸伤5例,重物砸伤4例,机器伤3例。致伤部位包括:跖跗关节以远7例,跖骨中段以远5例,其中9例合并有跖骨和/或趾骨骨折。患足在清除坏死皮肤软组织后均出现不同程度的肌腱、骨外露,软组织缺损区域包括前足负重区,软组织缺损面积范围10cm×5cm^25cm×10cm。所有创面均使用股前外侧穿支游离皮瓣修复,切取皮瓣大小为12cm×7cm^27cm×12cm。结果本组10例皮瓣完全成活,2例皮瓣边缘部分坏死。术后10位患者获得随访,随访6~12个月,皮瓣生长良好,前足功能恢复理想,可负重行走,足底无溃疡形成。采用英国医学研究会提出的感觉功能评定标准进行评定:8例皮瓣感觉恢复至S2,4例皮瓣恢复到S3。结论股前外侧中、下段皮瓣厚度与足底软组织厚度相近,阔筋膜坚韧而致密,类似足底组织结构,可很好的恢复足底耐磨、耐压、缓冲震荡的功能。游离此部位的穿支皮瓣修复前足脱套伤是一种较为理想的方法。

Objective To introduce the clinical experience and the efficacy on the repairment of forefeet degloving injury applied by microsurgical technique. Methods To apply anterolateral thigh perforator flap to repair the forefeet degloving injury in 12 patients of 10 male and 2 female from Septmeber 2012 to December 2013. The injured causes were vehicle accident 5 cases, bruised by heavy weight 4 cases, and machine injury 3 cases. The injured positions were distal to tarsometatarsal joint 7 cases and distal to metatarsal middle part 5 cases, thereinto, 9 cases of combined metatarsal fractures and / or phalangeal fractures. Different degree of tendon and bone exposure had been appeared on injured feet after the scavenging of necrotic skin and soft tissue, with the defect area including forefeet weight-bearing area, the defect area extent 10cm×5cm to 25cm×10cm. All wounds were repaired by anterolateral thigh perforator flap, with the cut flap size of 12cm×7cm to 27cm×12cm. Results 10 cases of flap were survival completely, with 2 cases of partial necrosis in the margin of flap. After operation in the 10 patients, 6 to 12 months followedup showed that, the flap grew well, the forefeet function were recovery perfectly, passable loaded walking, without ulceration formed on plantar. The sensation of 8 cases flap had recovered to S2, and 4 cases flap had recovered to S3, which were judged according to the evaluation standard of sensory function put forward by British Medical Research Council（BMRC）. Conclusion The thickness of anterolateral thigh middle and distal segment flap, which is similar to the soft tissue thickness of plantar, with tenacious and pyknotic fascia lata, is similar to the organization structure of plantar, could better recover the plantar function of wear, withstand voltage, and buffer concussion. Anterolateral thigh perforator flap to repair the forefeet degloving injury is a better reasonable method.