以旋髂浅动脉为血供的骨皮瓣修复足部复合组织缺损

Bone flaps supplied by the superficial circumflex iliac artery to repair foot composite tissue defects

目的 探讨以旋髂浅动脉(superficial circumflex iliac artery, SCIA)为血供的骨皮瓣修复足部复合组织缺损的临床疗效。方法 回顾性分析2019年6月—2021年6月泸州市骨病医院骨科应用以SCIA为血供的复合组织瓣修复足部组织缺损17例,男性12例,女性5例;年龄32~63岁,平均40.2岁。道路交通伤9例,压砸伤8例,受伤部位均在踝关节以远。创面在Ⅰ期清创后均伴有皮肤、骨骼缺损,骨骼缺损最大达7.2cm×4.2cm×2.2cm,创面缺损面积6.0cm×5.0cm~22.5cm×12.0cm,皮瓣切取面积6.5cm×5.5cm~23.0cm×12.0cm。皮瓣供区均采用Ⅰ期美容缝合。门诊定期随访,随访时观察骨皮瓣的外形、颜色、质地、骨愈合情况及供区的愈合情况。结果 骨皮瓣顺利成活15例,术后12h内出现动脉危象2例,经手术探查后血管再通畅,骨瓣完全成活。随访时间3~18个月,平均10.5个月,末次随访足部功能按美国矫形外科足踝协会评分标准评定:优10例,良5例,可2例。结论 SCIA骨皮瓣穿支丰富,可切取带血供的髂骨填补足部骨骼缺损,修复足部复合组织缺损,对恢复足部功能具有较好的临床疗效。

Objective To investigate the clinical effect of bone flaps supplied by the superficial circumflex iliac artery(SCIA)in repairing the composite tissue defect of the foot.Methods A retrospective analysis was conducted on 17 cases of foot tissue defects repaired in Luzhou Hospital of Osteopathy from Jun.2019 to Jun.2021,by using composite tissue flaps with the blood supply from the SCIA.There were 12 males and 5 females aged 32-63 years,mean 40.2 years.Among them,9 were traffic accident injuries and 8 were crush injuries,all affecting the foot areas far from the ankle joint.After the first-stage debridement,skin and/or bone defects were observed in all the cases.The maximum bone defect was 7.2cm×4.2cm×2.2cm.The size of the wound tissue defect was 6.0cm×5.0cm-22.5cm×12.0 cm,and the cutting size of the flap was 6.5cm×5.5cm-23.0cm×12.0cm.Cosmetic suture was conducted in one-stage for the donor site.Patients were followed up regularly at the outpatient department to observe the shape/color/texture of the flap,bone union and healing of the donor site.Results Bone flaps survived smoothly in 15 cases;2 cases had arterial crisis within 12 h after surgery,which survived completely after surgical exploration to reopen the blood vessels.The follow-up time was 3 to 18 months,mean 10.5 months.At the last follow-up,the foot function was evaluated using the American Orthopaedic Foot and Ankle Society score,which was excellent in 10 cases,good in 5,and fair in 2.Conclusion The SCIA-based bone flap,with abundant perforators and additional advantage of filling the foot bone defect with blood-supplied iliac bone flap,is reliable to repair complex tissue defects of the foot and achieve good foot functional recovery.