股前外侧flow—through皮瓣联合腓骨（皮）瓣修复小腿复合组织缺损

Transplantation of flow-through anterolateral thigh flap combined with fibular flap for reconstruction of composite tissue defects at leg

目的探讨股前外侧flow—through皮瓣联合腓骨（皮）瓣移植修复小腿复合组织缺损的方法及临床效果。方法收治小腿复合组织缺损共12例，采用股前外侧flow—through皮瓣联合腓骨（皮）瓣修复小腿皮肤软组织缺损及骨缺损，皮肤软组织缺损面积6cm×12cm～12cm×20cm，骨缺损长度4—10cm。股前外侧皮瓣面积14cm×8cm～23cm×13cm，腓骨段切取长度7～13cm，腓骨（皮）瓣面积为6cm×4cm～12cm×6cm。结果12例组织瓣均成活，移植腓骨均获骨性愈合，2例皮瓣于术后1d出现血管危象，经探查处理后缓解，1例皮瓣远端边缘部分坏死，经换药伤口逐渐愈合。术后随访8～36个月，所有皮瓣质地柔软，形态及功能满意，未出现供区并发症。结论股前外侧flow-through皮瓣联合腓骨（皮）瓣在修复小腿皮肤软组织缺损的同时能够修复骨缺损，是修复小腿大面积复合组织缺损较理想的方法。

Methods To explore the transplantation of flow-through anterolateral thigh flap combined with fibular flap for reconstruction of composite tissue defect at leg. Method 12 cases with leg composite tissue defects were reconstructed by flow-through anterolateral thigh flaps combined with fibular flaps. The skin defects ranged from 6 cm × 12 cm to 12 cm ×20 cm. The bone defects were 4 - 10 cm in length. The size of flow-through anterolateral thigh flaps was 14 cm × 8 cm to 23 cm× 13 cm and the fibular osteocutaneous flaps were 6 cm ×4 cm to 12 cm ×6 cm. The fibular bone was harvested as 7 cm to 13 cm in length. Results All the flaps survived in 12 cases. Bony reunion was achieved in all the cases. Vascular crisis happened in 2 cases 1 day after operation. Margin necrosis occurred in distal end of one flap, which healed after dressing. All the flaps had soft texture with satisfactory cosmetic and functional result. There was no complication in donor sites. Conclusions Flow-through anterolateral thigh flap combined with fibular flap can reconstruct soft tissue defect and bone defect simultaneously. It is the ideal method for leg composite tissue defects.