桥式交叉游离背阔肌皮瓣修复小腿以远胫血管损伤的复合组织缺损.docVIP

桥式交叉游离背阔肌皮瓣修复小腿以远胫血管损伤的复合组织缺损 　　【摘要】 目的：探讨桥式交叉游离背阔肌皮瓣修复小腿以远胫血管损伤的复合组织缺损的临床疗效。方法：选择2011年4月-2015年2月本院收治的9例小腿以远胫血管损伤的复合组织缺损病例作为研究对象，所选患者均采用桥式交叉游离背阔肌皮瓣修复损伤。结果：术后4周断蒂，随访6～24个月，皮瓣全部成活，外形、色泽、质地满意，患肢恢复负重功能。结论：桥式交叉游离背阔肌皮瓣，切取范围大，血供可靠，可改善受区局部血液循环，且不损伤患肢血管，有利于皮瓣与受区血供建立，是修复小腿以远胫血管损伤的复合组织缺损创面较为理想的方法 【关键词】 小腿； 背阔肌皮瓣； 显微外科手术； 桥式交叉移植 【Abstract】 Objective：To probe into the clinical efficacy regarding restoration of distal tibial vascular injury-based composite tissue defects by bridge-crossing with free latissimus dorsi flaps.Method：Nine patients with distal vascular injury-based composite tissue defects in our hospital from April 2011 to February 2015 were selected as the research objects.They were treated by bridge-crossing with free latissimus dorsi flaps.Result：The pedicles were cut off 4 weeks after the operation.All patients got follow-up from 6 months to 24 months. All the flaps survived with satisfactory appearance，color and texture，and the injured limbs regained weight-bearing capacity.Conclusion：The bridge-crossing method with free latissimus dorsi flaps is ideal for restoration of distal vascular injury-based composite tissue defects with wide cutting ranges，reliable blood supply，improved local blood circulation in recipient areas，as well as zero damage to blood vessels in injured limbs，which can help establish blood supply between the flaps and the recipient areas. 【Key words】 Calf； Latissimus dorsi flap； Microsurgery； Cross-bridge transplantation First-authors address：Ningbo Beilun Small Harbor Hospital，Ningbo 315810，China doi：10.3969/j.issn.1674-4985.2015.28.017 小腿以远严重创伤常存在广泛的复合组织缺损，伴骨、肌肉、肌腱、血管等损伤，损伤结构复杂，创面大，修复困难，处理不当可能导致肢体坏死，甚至截肢，不仅给患者带来肉体及精神上的痛苦，而且增加了家庭及社会的负担。为保住患肢及恢复患肢功能，学者们采用不同的方法进行修复，但疗效不一[1-5]。2011年4月-2015年2月，本院采用桥式交叉游离背阔肌皮瓣修复小腿以远胫血管损伤的大面积复合组织缺损9例，取得满意疗效，现报道如下 1 资料与方法 1.1 一般资料 选择2011年4月-2015年2月本院收治的小腿以远胫血管损伤的大面积复合组织缺损患者9例作为研究对象，其中男6例，女3例；年龄18～47岁，平均34.9岁。致伤原因：交通事故伤6例，重物砸伤2例，机器绞伤1例。损伤部位：小腿及踝部皮肤软组织缺损伴肌肉、肌腱、骨外露5例，其中2例胫腓骨骨折并部分缺损；小腿皮肤软组织缺损伴肌肉、肌腱、骨