摘要
目的探讨皮瓣移植联合Ilizarov技术一期修复下肢大面积复合组织缺损的临床应用效果。方法回顾性分析2008年7月至2013年7月收集接受皮瓣移植联合Ilizarov技术一期修复小腿大面积复合组织缺损16例患者的临床资料．其中男12例，女4例．年龄22～62岁，平均42．6岁。软组织缺损面积8cm×9cm～30cm×20cm．骨缺损长度2～14cm。根据小腿局部软组织条件及复合组织缺损面积大小，计划具体修复方式，其中游离组织瓣覆盖小腿软组织缺损10例，局部皮瓣转移修复小腿软组织缺损6例（隐神经营养血管皮瓣3例，腓肠神经营养血管皮瓣3例）。术后每日监测皮瓣皮温变化。术后10～14d开始行骨迁移，迁移频率1mm／d，分4次完成。结果术后随访18～36个月．16例皮瓣术后完全成活，仅1例隐神经营养血管皮瓣术后2d出现静脉回流障碍．后自行缓解。外固定支架佩戴时间3．5～18．O个月，牵长骨成骨良好，所有患者均得到了骨愈合。所有患者均对治疗效果满意。结论皮瓣移植联合Ilizarov技术一期修复小腿大面积复合组织缺损能明显缩短患者治疗时间．提高牵长骨的成骨能力及抗感染能力。
Objective To determine the outcome of the combined use of flaps transfer and ilizarov technique reconstruct the large soft tissue defects and bone lose in the lower leg. Methods Sixteen patients were identified from a retrospective review from July, 2008 to July, 2013, who suffered the large soft tissue defects and bone lose in the lower leg and underwent single-stage soft tissue and osseous reconstruction using the flap technique and Ilizarov method. There were 12 males and 4 females aged from 22 to 62 years old （average 42.6 years old）. The size of soft tis- sue defect ranged from 8 cm×9 cm to 30 cm×20 cm. The length of the bone discrepancy ranged from 2 to 14 cm. According to the local condition of the lower leg and the size of the composite tissue defects, 10 patients received the free flap covering, 6 patients repaired by the saphenous neurocutaneous perforator flap （3 cases） and sural nerve neurocu- taneous flap （3 cases）. Daily monitoring the skin temperature postoperative. Distraction was commenced on postopera- tive day 10 to 14 at the rate of 1 mm/day and continued in 4 equal increments. Results The follow-up time ranged from 18 to 36 months. Sixteen flaps survived completed, only 1 flap was observed the venous congestion in postopera- tive day 2. The duration of ilizarov application ranged from 3.5 to 18.0 months. All patients achieved final union. All patients were satisfied with the outcome of the surgery. Conclusion The combined use of neurocutaneous flap and Ilizarov technique for reconstruction of large composite soft tissue defect in the lower leg. Significantly reduce patient treatment time, improving traction osteogenesis of long bones and the ability of resistance to infection.
出处
《中华显微外科杂志》
CSCD
北大核心
2017年第3期225-228,共4页
Chinese Journal of Microsurgery
基金
卫生部行业基金公益项目（201402016）
国家自然科学基金面上项目（81572122）
上海市卫生和计划生育委员会基金项目f20144Y0256）
