本文選題：游離股前外側(cè)皮瓣 + 穿支　； 參考：《浙江大學(xué)》2015年碩士論文

【摘要】：背景：高能量損傷導(dǎo)致的軟組織骨質(zhì)損傷嚴(yán)重,治療過程中經(jīng)常面臨軟組織、骨質(zhì)壞死感染缺損等問題,加上不合適手術(shù)等的二次打擊和多次徹底的清創(chuàng),軟組織及骨質(zhì)缺損更加嚴(yán)重。目前國內(nèi)外治療方法主要有Papineau技術(shù)、ilizarov技術(shù)和骨搬運技術(shù)、皮瓣覆蓋技術(shù)、肌皮瓣覆蓋技術(shù)、帶血管游離骨移植技術(shù)等,其中Papineau技術(shù)、ilizarov技術(shù)和骨搬運技術(shù)、帶血管游離骨移植技術(shù)主要用于治療一小部分軟組織骨缺損范圍較少或者骨缺損較多的病例,大多數(shù)的患者需要皮瓣和肌皮瓣覆蓋技術(shù)治療,其中需要用肌皮瓣覆蓋技術(shù)的又占多數(shù),但肌皮瓣覆蓋技術(shù)供區(qū)損傷較大,且受區(qū)臃腫,對于深部不規(guī)則骨質(zhì)缺損填塞效果不確切。近年來隨著顯微外科的發(fā)展,國內(nèi)外學(xué)者的研究主要集中在穿支皮瓣治療慢性骨髓炎,但不能解決慢性骨髓炎伴軟組織缺損遺留深部腔隙的問題。本研究旨在使用穿支肌瓣靈活填塞殘腔,同時減少供區(qū)損傷及受區(qū)臃腫問題,減少并發(fā)癥,推動穿支皮瓣治療慢性骨髓炎的發(fā)展。目的：探討嵌合型游離股前外側(cè)穿支皮瓣治療慢性骨髓炎伴四肢軟組織缺損的療效。方法：2012年6月-2015年6月使用嵌合型游離股前外側(cè)穿支皮瓣治療慢性骨髓炎伴四肢軟組織缺損15例,男11例,女4例,致傷原因：車禍傷6例,砸傷4例,壓傷3例,高處墜落傷2例。其中脛骨慢性骨髓炎11例,跟骨慢性骨髓炎2例,橈骨骨髓炎1例,掌骨骨髓炎1例。結(jié)果：15例皮瓣,1例出現(xiàn)血管危象,術(shù)后第三天出現(xiàn)皮瓣略紫,張力略高,考慮血腫形成,拆除縫線擠壓皮瓣有血凝塊溢出,予引流換藥,皮瓣色澤及張力恢復(fù)。2例皮緣部分壞死,給予游離植皮及局部皮瓣轉(zhuǎn)移好轉(zhuǎn)。1例骨髓炎復(fù)發(fā),經(jīng)過兩次清創(chuàng)、病灶切除好轉(zhuǎn)。14例感染未復(fù)發(fā),其中10例術(shù)后自體骨加人工骨植骨愈合,3例未植骨愈合,1例因繼發(fā)創(chuàng)傷性關(guān)節(jié)炎性行關(guān)節(jié)融合愈合。隨訪6-23月,平均隨訪13.2月,皮瓣色澤與受區(qū)相似,無明顯臃腫,外形美觀,供區(qū)肢體運動功能無明顯影響,供區(qū)切口線型愈合,瘢痕略有攣縮。結(jié)論：嵌合型游離股前外側(cè)皮瓣使皮瓣和肌瓣即相互獨立,又通過同一供血動脈相互聯(lián)系,設(shè)計成的穿支肌瓣較肌皮瓣能較好的填塞骨缺損腔隙,滿足慢性骨髓炎殘留骨缺損腔隙消除的需要,同時供區(qū)肌肉損傷減少,功能影響減少。另外供區(qū)隱蔽,切口線形愈合,受區(qū)不臃腫,符合美學(xué)要求,是治療慢性骨髓炎伴四肢軟組織缺損的一個較好的選擇。
[Abstract]:Background: the soft tissue bone injury caused by high energy injury is very serious. In the course of treatment, the soft tissue, osteonecrosis, infection and defect are often faced with the problems of secondary attack and multiple thorough debridement. Soft tissue and bone defects are more serious. At present, the main treatment methods at home and abroad include Papineau technique and bone handling technique, flap covering technique, musculocutaneous flap covering technique, vascularized free bone graft technology, etc. Among them, Papineau technique and bone handling technology. The technique of vascularized free bone transplantation is mainly used to treat a small number of cases with less or more bone defects in soft tissue. Most of the patients need flap and myocutaneous flap covering technique to treat them. Most of them need to be covered by myocutaneous flap, but the donor area of myocutaneous flap covering is larger and the area is bloated, so the effect of tamponade on deep irregular bone defect is not accurate. In recent years, with the development of microsurgery, scholars at home and abroad mainly focus on perforating flap in the treatment of chronic osteomyelitis, but it can not solve the problem of deep space left by chronic osteomyelitis with soft tissue defect. The purpose of this study was to use perforator muscle flap to fill the residual cavity flexibly, reduce donor area injury and bloated area, reduce complications, and promote the development of perforator flap in the treatment of chronic osteomyelitis. Objective: to evaluate the efficacy of chimeric free anterolateral femoral perforator flap in the treatment of chronic osteomyelitis with soft tissue defect of extremities. Methods: from June 2012 to June 2015, 15 cases (11 males and 4 females) of chronic osteomyelitis with soft tissue defect of extremities were treated with chimeric free anterolateral femoral perforator flap. The causes of injury were: 6 cases of traffic accident, 4 cases of smashing injury and 3 cases of compression injury. There were 2 cases of falling injury. There were 11 cases of chronic osteomyelitis of tibia, 2 cases of chronic osteomyelitis of calcaneus, 1 case of radial osteomyelitis and 1 case of metacarpal osteomyelitis. Results the vascular crisis was found in 1 case of 15 cases of skin flap. The third day after operation, the flap appeared purple slightly, the tension was slightly higher. Considering the formation of hematoma, there was blood clot overflow in the decompressed suture flap. The color and tension of the flap recovered in 2 cases, the free skin graft and the local flap transfer were given to improve the recurrence of osteomyelitis. After two debridement, the lesion was resected and improved in 14 cases, and the infection did not recur. Among them, 10 cases were healed with autogenous bone and artificial bone graft. 3 cases without graft union and 1 case with secondary traumatic arthritis underwent joint fusion healing. The skin flap was followed up for 6-23 months and followed up for an average of 13.2 months. The color of the flap was similar to that of the recipient area, no obvious bloated appearance, no obvious effect on the motor function of the donor limb, the line healing of the donor incision and a slight contracture of the scar. Conclusion: the interlocking free anterolateral femoral flap makes the flap and muscle flap independent of each other, and through the same blood supply artery, the perforating branch muscle flap is better than the musculocutaneous flap in filling the space of bone defect. It can meet the need of eliminating the lacunae of residual bone defect in chronic osteomyelitis, and reduce the muscle injury and functional impact of donor area. In addition, the donor area is concealed, the incision is linear healing, and the recipient area is not bloated, which meets the aesthetic requirements. It is a better choice for the treatment of chronic osteomyelitis with soft tissue defect of extremities.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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