带胫骨隐神经复合组织皮瓣在小腿创伤性骨与皮肤缺损中的临床应用

Clinical application of tibial composite saphenous nervetissue flap for the treatment of traumatic bone-skin defect of leg

目的 :探讨带胫骨隐神经复合组织皮瓣在修复小腿创伤性骨与皮缺损中的应用及临床疗效。方法 :自2009年2月至2015年5月,收治因外伤致小腿骨皮缺损患者23例,男18例,女5例;年龄8~59岁,平均35.6岁。胫骨骨皮质缺损长度4~12 cm,宽2~2.5 cm;皮肤缺损范围8 cm×3 cm^18 cm×11 cm,创面均有脓性渗出物。采用带胫骨隐神经复合组织皮瓣交腿移位和同侧移位方法,重建患肢胫骨支架连续性并修复创面。切取皮瓣范围9 cm×4 cm^20 cm×12 cm,骨瓣长度为6~15 cm,宽1.5~2.5 cm。观察骨折愈合时间及肢体功能恢复情况。结果 :术后3~5个月骨瓣与受区胫骨愈合,平均4.7个月。23例获随访,时间6个月~5年,平均30.3个月。13例均能负重行走,步态无明显异常,能从事原工作。术后按照Enneking等评价系统,优13例,良8例,差2例。结论:根据患肢具体情况采用带胫骨的隐神经复合皮瓣移植Ⅰ期修复胫骨及皮肤缺损,成功率高,对供区肢体损伤小,是修复小腿骨皮缺损的理想治疗方法。

Objective To investigate the effect of tibial composite saphenous nerve tissue flap in repairing traumatic bone skin defect of leg. Methods：From February 2009 to May 2015,23 patients with focile skin defect caused by trauma were treated,including 18 males and 5 females,aged from 8 to 59 years old with an average age of 35.6 years old. Length of tibia bone cortex defect ranged from 4 to 12 cm,width ranged from 2 to 2.5 cm,skin defect ranged from 8 cm×3 cm to 18 cm × 11 cm,all the wound surfaces had purulent exudation. Cross shift and ipsilateral shift methods of tibial composite saphenous nerve tissue flap were used to reconstruct continuity of the injured limb tibial brace and repair wound surface. Cutting flap ranged from 9 cm×4 cm to 20 cm × 12 cm,bone flap length was 6 to 15 cm,width was 1.5 to 2.5 cm. Fracture healing time and recovery of limb function were observed. Results：At 3 to 5 months after operation,bone flap and area of affected area were healed with an average of 4.7 months. Twenty-three cases were followed up for 6 months to 5 years with an average of 30.3 months. Thirteen patients were able to walk without abnormal gait and could be engaged into original work. According to Enneking evaluation systems,13 patients obtained excellent results,8 moderate and 2 poor. Conclusion：With tibial composite saphenous nerve tissue flap transplantation at stage one to repair tibia and skin defects according to specific condition of affected limbs has a high rate of success and creates less damage to region of limb injury,which is an ideal method to repair skin defect of focile.