腓骨长短肌游离复合组织瓣治疗四肢复杂创伤

Yunchu Sun, Gen Wen, Jia Xu, Fengji Xu, Yimin Cai
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A fibular composite tissue flap was designed according to the soft tissue condition and defect area to repair and fixate the bone defect after thorough debridement and cover the wound before functional reconstruction. Postoperatively, survival of the flap and functional recovery of the corresponding tendon at the recipient site, healing time of the tibia, and wound healing, ankle motion and complications at the donor site were all observed. \n \n \nResults \nThe 5 patients were followed up for 18 to 38 months (average, 25.2 months). All flaps survived without any vascular crisis or infection. The union time for the fibular graft ranged from 4 to 16 months (average, 8.4 months). In the 3 patients with a tibial defect, the maximum angle of dorsal extension ranged from 0° to 10° and no foot drop was observed. Thumb and digital flexion was reconstructed in the patients with a forearm bone defect only to achieve opposition of index finger and thumb but we failed to make them have a fist. 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摘要

目的报道腓骨长、腓骨短肌游离复合组织瓣治疗四肢复杂创伤的临床应用。方法2014年8月至2017年9月,在上海市第六人民医院骨科,对5例四肢复杂创伤患者采用腓骨长、短肌复合组织游离皮瓣进行治疗。他们是4男1女,年龄从23岁到52岁(平均35.1岁)。所有患者均存在肌腱缺损;一个桡骨缺损,一个尺骨缺损,三个胫骨缺损。骨缺损的长度从8cm到18cm不等;软组织缺损大小从10cm×5cm到18cm×8cm不等。根据软组织状况和缺损面积设计腓骨复合组织瓣,在彻底清创后修复固定骨缺损,在功能重建前覆盖伤口。术后,观察皮瓣的存活率和受体部位相应肌腱的功能恢复、胫骨的愈合时间以及供体部位的伤口愈合、踝关节运动和并发症。结果5例患者随访18~38个月,平均25.2个月。所有皮瓣均存活,无任何血管危象或感染。腓骨移植物的愈合时间为4-16个月(平均8.4个月)。在3例胫骨缺损患者中,最大背侧伸展角度为0°至10°,未观察到足下垂。对前臂骨缺损患者进行拇指和指屈重建,仅实现食指和拇指的相对,但未能使他们握拳。在5个皮瓣供区,真空抽吸后第二阶段缝合,伤口愈合良好;其中一个身上形成了明显的疤痕。供区未见明显足内翻。患者的踝关节活动情况令人满意。随访期间未发生腓骨移植物再骨折。结论腓骨长短肌游离复合组织瓣是治疗四肢复杂创伤的良好选择。关键词:外科皮瓣;腓骨;复合组织缺陷;腓骨骨皮瓣
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Free fibular composite tissue flap with peroneus longus and brevis for complicated extremity trauma
Objective To report our clinical application of free fibular composite tissue flap with peroneus longus and brevis in the treatment of complicated extremity trauma. Methods From August 2014 to September 2017, 5 patients with complicated extremity trauma were treated using a free fibular composite tissue flap with peroneus longus and brevis at Department of Orthopaedics, The Sixth People's Hospital of Shanghai. They were 4 men and one woman, aged from 23 to 52 years (average, 35.1 years). All of them had tendon defects; one had a radius defect, one an ulnar defect and three a tibial defect. The length of bone defects ranged from 8 cm to 18 cm; the size of soft tissue defects ranged from 10 cm × 5 cm to 18 cm ×8 cm. A fibular composite tissue flap was designed according to the soft tissue condition and defect area to repair and fixate the bone defect after thorough debridement and cover the wound before functional reconstruction. Postoperatively, survival of the flap and functional recovery of the corresponding tendon at the recipient site, healing time of the tibia, and wound healing, ankle motion and complications at the donor site were all observed. Results The 5 patients were followed up for 18 to 38 months (average, 25.2 months). All flaps survived without any vascular crisis or infection. The union time for the fibular graft ranged from 4 to 16 months (average, 8.4 months). In the 3 patients with a tibial defect, the maximum angle of dorsal extension ranged from 0° to 10° and no foot drop was observed. Thumb and digital flexion was reconstructed in the patients with a forearm bone defect only to achieve opposition of index finger and thumb but we failed to make them have a fist. At the 5 flap donor sites, the wound was sutured by the second stage after vacuum suction and healed well; obvious scar formed in one of them. No obvious foot varus was observed at the donor site. The patients were satisfactory with their ankle joint motion. No refracture of the fibular graft occurred during follow-up. Conclusion A free fibular composite tissue flap with peroneus longus and brevis is a good choice for complicated extremity trauma. Key words: Surgical flaps; Fibula; Composite tissue defects; Fibular osteocutaneous flap
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