两种类型游离股薄肌肌皮瓣修复小腿复杂创面

Reconstruction of complex wound in calf with two types of free gracilis musculocutaneous flap

目的探讨横向及纵向两种类型游离股薄肌肌皮瓣修复小腿复杂创面的临床效果。方法采用回顾性病例系列研究分析新疆医科大学第一附属医院骨科中心显微修复外科2019年8月至2023年1月收治的22例小腿复杂单一创面患者的临床资料,男12例,女10例;年龄26~58岁,平均46.7岁;左侧12例,右侧10例;车祸外伤9例,医源性并发症8例,骨感染性疾病3例,肿瘤切除术后2例。创面面积10.0 cm×5.0 cm~15.0 cm×7.0 cm;设计、切取游离横向(16例)或纵向(6例)股薄肌肌皮瓣修复小腿复杂创面,股薄肌肌皮瓣面积12.0 cm×6.0 cm~22.0 cm×9.0 cm。记录股薄肌肌皮瓣切取时间及手术时间,切取时间40~60 min,手术时间3~5 h。供区直接拉拢缝合。术后通过门诊、电话、微信进行定期随访,观察皮瓣成活情况、远期皮瓣外形、供区和受区愈合情况及患肢功能。结果术后22例皮瓣全部成活,1例皮瓣边缘青紫,皮缘渗血多,急诊手术探查发现股薄肌肌皮瓣近端带有的大隐静脉与受区大隐静脉吻合口栓塞,经过取栓后再次吻合皮瓣完全成活。大腿供区均Ⅰ期愈合,功能良好。随访5~25个月,平均14.42个月。皮瓣色泽、质地良好,受区创面愈合、无肿胀,感染创面得到控制。患肢功能采用Punor功能评定标准进行评定:优15例,良5例,可2例。结论应用横向和纵向两种类型游离股薄肌肌皮瓣是修复小腿复杂创面的有效方法;将股薄肌肌皮瓣近端带有的大隐静脉与受区大隐静脉或小隐静脉吻合,能够减少静脉危象的发生。

ObjectiveTo investigate the clinical effect of two types of free gracilis musculocutaneous flap in transverse or vertical for reconstruction of the complex wound in calf.MethodsA retrospective series case study was conducted to analyse the clinical data of 22 patients who were treated in the Department of Microrepair and Reconstruction,the First Affiliated Hospital of Xinjiang Medical University for complex single wounds in calf from August 2019 to January 2023.The patients were 12 males and 10 females and aged 26-58 years old,with 46.7 years old in average.There were 12 wounds on the left calf and 10 on the right.Nine of the wounds were of car accident,8 of iatrogenic complications,3 of bone infection and 2 of tumour resection.The wounds sized at 10.0 cm×5.0 cm-15.0 cm×7.0 cm.Sixteen transverse gracilis myocutaneous flaps and 6 vertical gracilis myocutaneous flaps were designed and harvested to reconstruct complex wounds in calf.The flaps were 12.0 cm×6.0 cm-22.0 cm×9.0 cm in size.Time for the gracilis myocutaneous flap harvesting and the time for whole surgery were recorded.The time for flap harvest was 40-60 minutes and the time for the whole surgery was 3-5 hours.Flap donor sites were directly sutured.All patients were included in the regular postoperative follow-up at outpatient clinic or through telephone and WeChat interviews and the flap survival,long-term flap appearance,healing of donor and recipient sites and limb functions were observed.ResultsAll 22 flaps survived after surgery.One flap had a blue edge with blood oozing.Urgent surgical exploration revealed that embolization occurred at the anastomotic site between the great saphenous vein at the proximal end of the flap and the great saphenous vein at the recipient site.After removal of the thrombus,the veins were re-anastomosed and flap survived.All the donor sites healed in stage one and functioned well.All patients entered postoperative follow-up for 5-25 months,14.42 months in average.The flaps were in satisfactory appearance with good texture.All recipient sites healed without complication.The infected wounds were controlled.Function of the limbs was evaluated according to the Punor functional assessment criteria with excellent for 15 patients,good for 5 and fair for 2.ConclusionApplication of free transverse and vertical layout of gracilis musculocutaneous flap is an effective method to reconstruct a complex wound in calf.The anastomosis of the great saphenous vein at the proximal end of the gracilis muscle flap with great saphenous vein or small saphenous vein at the recipient site can reduce the occurrence of venous occlusion.