膜诱导技术联合股前外侧皮瓣移植修复足部复合缺损

Induced membrane technique combined with anterolateral thigh flap transfer for reconstruction of composite foot defect

目的探讨膜诱导技术联合股前外侧皮瓣移植修复足部复合缺损的疗效方法采用回顾性病例系列研究分析2014年2月至2018年12月解放军联勤保障部队第九二〇医院收治的7例足部复合缺损患者临床资料,其中男5例,女2例;年龄20〜73岁[(38.9±16.3)岁],前足复合缺损5例,中足1例,后足1例。跖骨缺损9块,内侧楔骨缺损1块,跟骨缺损1块。创面缺损面积为6cm×5cm〜70cm×35cm。Ⅰ期行股前外侧皮瓣移植、万古霉素骨水泥植入。观察皮瓣成活、并发症情况。Ⅱ期行骨水泥取出,诱导膜内植骨观察植骨间隔时间、骨愈合时间。比较术前及末次随访时Maryland足部功能评分、术后并发症.结果患者均获随访22~54个月[(33.8±9.7)个月]。Ⅰ期术后7例皮瓣均成活,皮瓣臃肿3例;1例后足跟骨复合缺损术后反复感染,予以清创处理。Ⅱ期植骨6例,植骨间隔时间2~4个月[(2.8±0.9)个月];骨愈合时间3~7个月[(4.7±1.2)个月]末次随访时Maryland足部功能评分为63~92分[(82.1±8.7)分],与术前0分比较,差异有统计学意义(P<O.O1),其中优1例,良5例,中1例术后1块跖骨骨不连,其余8块植骨均顺利愈合。结论膜诱导技术联合股前外侧皮瓣移植是修复足部复合缺损的有效方法,能较好地修复软组织和骨缺损,恢复良好的行走功能。

Objective To investigate the efficacy of induced membrane technique combined with anterolateral thigh flap transfer in treating composite foot defect.Methods A retrospective case series study was performed for 7 patients with composite foot defect treated al 920th Hospital of Joint Logistic.Support Force of PLA from February 2014 to December 2018.There were 5 males and 2 females,with the age of 20-73 years[(38.9±16.3)years].The composite defect located at the forefoot in 5 patients,midfoot in 1,and hindfoot in 1.There were 9 metatarsal bone defects,1 medial cuneiform bone defect,and 1 calcaneus bone defect.The size of soft tissue defect varied from 6 cm × 5 cm to 70 cm × 35 cm.At stage Ⅰ,the anterolateral thigh flap transfer and vancomycin loaded cement implantation were performed.The flap survival and complications were recorded.At stage Ⅱ,the cement was removed and autogenous bone was grafted into the induced membrane.The duration of two-stage operation,hone union time,and complications were recorded.The postoperative function was assessed using Maryland foot score system before operation and at the last follow-up and postoperative compications were documented.Results All patients were followed up for 22-54 months[(33.8±9.7)months].At stage Ⅰ,flaps survived in all patients,and bulking of the flap was seen in 3 patients.One patient with calcaneus hone defect had repeated infection after operation,and received debridement.At stage Ⅱ,6 patients received bone grafting surgery.The duration of two-stage operation was 2-4 months[(2.8±0.9)months].The hone union time was 3 and 7 months[(4.7±1.2)months].At the last follow-up,the Maryland foot function score was 63-92 points[(82.1±8.7)points],significantly different from 0 point before operation(P<0.01).The results were excellent in 1 patient,good in 5,and fair in 1.Except for one nonunion of metatarsal hone,all the other 8 sites were with bone union uneventfully.Conclusion The induced memfjrane technique combined with anterolateral thigh flap transfer is an effective protocol for composite foot defect,which can well repair soft tissue and bone defect,and restore walking.