改良腓肠肌内侧头肌皮瓣转位修复小腿胫前骨髓炎骨外露创面

Transposition of modified medial gastrocemius musculocutaneous flap to repair bone exposed wound of anterior tibial osteomyelitis of the calf

目的探讨去除蒂部肌肉的带血管蒂腓肠肌内侧头肌皮瓣转位修复小腿胫前骨髓炎骨外露创面的临床疗效。方法2009年1月-2019年1月,对18例因小腿严重创伤后遗留胫前骨髓炎骨外露创面,采取骨创面扩创、带血管蒂腓肠肌内侧头肌皮瓣转位修复。结果术后17例肌皮瓣完全成活,创面达到一次性覆盖修复及一期愈合,1例肌皮瓣术后第2天出现静脉危象,虽经调整,肌皮瓣远端1/5处仍出现坏死情况,经后期扩创、皮瓣拉伸推移后达到完全覆盖及治愈创面效果,成功率94.4%。术后随访4~48个月,无皮肤溃疡及骨髓炎复发迹象,小腿和足踝功能、皮瓣受供区外观及皮肤感觉恢复满意。结论应用去除蒂部肌肉的带血管蒂腓肠肌内侧头肌皮瓣转位修复小腿胫前骨髓炎骨外露创面,手术操作简单,总体效果满意,具有良好的临床疗效。

Objective To explore and study the clinical efficacy of the pedicle muscle flap with vascularized gastrocnemius medial cephalocutaneous flap for transposition to repair the exposed bone wound of tibial anterior osteomyelitis of the calf.Methods Eighteen cases of tibial anterior osteomyelitis(tibial osteomyelitis)bone exposed after severe calf trauma were treated with bone wound expansion and medial gastrocnemius muscle with vascularized flap.Results Seventeen of 18 cases of myocutaneous flap survived completely,the wound to disposable cover repair and primary healing,1 case of myocutaneous flap in venous crisis after 2 days,was adjusted,distal 1/5 myocutaneous flap necrosis condition,by the late after debridement and skin flap tensile goes on to achieve full coverage and heal the wound effect,success rate of 94.4%,after postoperative follow-up of 4~48 months,no signs of recurrence of skin ulcer and osteomyelitis,the calf and ankle function,flap donor site appearance and restore skin sense of satisfaction.Conclusion The flap of medial head muscle of gastrocnemius muscle with vascular pedicle to remove the pedicle muscle can be used to repair and cure the exposed bone wound of anterior tibial osteomyelitis.