第2跖骨头复合组织瓣重建小儿外踝骨皮肤缺损

The head of second metatarsal bone and flap repair the lateral malleolus compound tissues defect in children

目的探讨第2跖骨头复合组织瓣重建小儿外踝骨皮肤缺损的临床效果。方法2009年7月至2018年5月,冀中能源邢台矿业集团有限责任公司总医院骨三科收治外踝骨及皮肤软组织缺损患儿4例,男3例,女1例;年龄4~13岁;右侧2例,左侧2例。均为外踝缺损伴邻近皮肤缺损,皮肤缺损范围2.0 cm×2.0 cm^4.0 cm×5.0 cm,骨缺损范围1.0~3.0 cm。切取患侧第2跖骨头复合组织瓣重建小儿外踝骨皮肤缺损,其中皮瓣面积2.5 cm×2.5 cm^4.5 cm×5.5 cm,第2跖骨头长度1.0~3.0 cm,供区直接缝合。术后影像学评价踝穴间隙及外踝纵向发育状况与健侧肢体是否同步;依据美国矫形足踝协会(AOFAS)制定的评分标准评估踝关节功能恢复状况;观察供区足部活动度有无影响,负重、行走有无影响。结果术后复合组织瓣全部成活,无血运障碍,供区愈合良好。患儿均获6个月至2年随访,皮瓣颜色及弹性较好,无瘢痕挛缩。无踝关节内翻畸形发生,负重及行走满意。影像学评价显示踝穴间隙及外踝纵向发育状况与健侧肢体大致同步,按AOFAS足踝功能评判标准评估:优2例,良2例。供区足部活动无影响,稳定性较好。结论第2跖骨头复合组织瓣可一期修复小儿外踝骨骺及邻近软组织缺损,重建外踝可随小儿的生长同步发育,是重建小儿外踝外伤性缺损的一种较好方法。

Objective To explore the clinic effects of the head of second metatarsal bone and flap for bone and skin defect at lateral malleolus in children.Methods Between July 2009 and May 2018,4 children with ankle bone and skin and soft tissue defects in the Jizhong Energy Xingtai Mig General Hospital were selected,including 3 boys and 1 girl aged 4-13 years old.All cases were lateral malleolus defect with adjacent skin defect,the range of skin defect was 2.0 cm×2.0 cm-4.0 cm×5.0 cm,and the range of bone defect was 1.0-3.0 cm.The area of the flap was 2.5 cm×2.5 cm-4.5 cm×5.5 cm,and the length of the second metatarsal head was 1.0-3.0 cm.The donor site was closed directly.After the operation,X-rays was performed to evaluate whether the ankle space and lateral malleolus longitudinal development was synchronized with the uninjured limb.Ankle joint function recovery was evaluated according to the American Orthopaedic Foot and Ankle Society(AOFAS).The outcomes of donor foot range of motion,weight-bearing,and walking were observed.Results All the composite tissue flap survived with good blood circulation,and all the donor sites healed well.All the child patients were followed up for 0.5-2.0 years.The color and elasticity of the flaps were good,without cicatricial contracture.The patients had no inversion of ankle joint,with satisfying loading and walking function.Imaging evaluation showed that the space between ankle points and the longitudinal development of lateral malleolus were roughly synchronous with the healthy side.Two cases were graded as excellent and 2 as good according to the standard of the AOFAS.The donor's foot had normal flexion and extension function,without instability.Conclusions The head of second metatarsal bone and flap can repair the epiphysis and soft tissue defect of lateral malleolus in children at one stage,and the reconstructed lateral malleolus can develop with the growth of children.It is a satisfactory method of reconstructing the traumatic defect of lateral malleolus in children.