筋膜蒂胫骨皮瓣转移修复骨与软组织缺损

Surgical technique of transfer of tibial bone-skin flap pedicled with fascia for repairing bone and soft tissue defects

[目的]介绍筋膜蒂胫骨皮瓣转移修复手术技术与初步临床结果。[方法]近端筋膜蒂胫骨皮瓣选择胫后动脉中上段穿支和隐动脉双重供血,远端蒂胫骨皮瓣应用胫后动脉内踝上穿支和隐神经营养支双重供血。转移修复同侧或对侧骨软组织缺损,皮肤软组织缺损3.00 cm×3.00 cm^7.00 cm×13.00 cm。骨缺损长度3.00~10.00 cm。[结果] 33例胫骨皮瓣全部成活,创面愈合时间14~70 d,平均(19.63±3.82) d。随访(30.21±11.77)个月,患肢功能逐渐恢复。参照Johner-Wmhs疗效评定标准:优25例,良5例,中3例,优良率为90.57%。[结论]此筋膜蒂胫骨皮瓣充分利用双重供血的优点,可切取较大面积,对供区影响小。

[Objective] To introduce surgical technique and primary clinical outcomes of transfer of tibial bone-skin flap pedicled with fascia for repairing ipsilateral or contralateral bone and soft tissue defects. [Methods] This bone-skin has double blood supplies, including the posterior tibial artery perforator and the saphenous artery at proximal tibia, while the medial malleolus branch of the posterior tibial artery and the saphenous nerve nutrient branch at distal tibia. It was used for repairing ipsilateral or contralateral soft tissue defects ranged from 3.0 cm×3.0 cm to 7.0 cm×13.0 cm in aera, and bone defect from 3.0 cm^10.0 cm in length. [Results] All the 33 patients got the transferred tibial bone-skin flap survived and wound healed in 14 to 70 days with a mean of(19.63±3.82) days. As time went during followed-up period of(30.21±11.77) months on average, function of the limbs recovered gradually. According to Johner-Wmhs criteria, the clinical outcomes was ranked as excellent in 25 cases,good in 5 cases and fair in 3 cases, with an excellent and good rate of 90.57%. [Conclusion] Taking advantage of double blood supplies, this bone-skin flap pedicled with fascia is available with relatively larger bone and skin, without serious impacts on the donor area.