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TREATMENT OF OSTEOCUTANEOUS DEFECT OF LEG BY REVERSED OR PERI0STEOCUTANEOUS FLAP OF TIBIA

This article introduced a newmethod of repaire of osteocutaneousdefect of the lower leg by thetransfer of periosteocutaneous flap.The donor artery was the posteriortibial artery which supplied the skinof the medial aspect of the middleand lower leg. The medial skin flapof the leg had vascular communicat-ion with the periostium of the ant-erior aspect of the tibia. The shapeand size of the flap could be design-ed according to the recipient area,and the flap axis should be along theline from medial tibial condyle to the medial malleolus, generelly at the level of 3.7.11. or 15cm above the medial malleolus. The skin defect could be repaired by free graft, and 2 patients received this operation had achieved good result after 1 year follow-up.

穿支血管筋膜蒂皮瓣修复胫前皮肤软组织缺损

目的 总结小腿穿支血管筋膜蒂皮瓣修复胫前皮肤软组织缺损的手术方法及疗效。 方法 2000 年1 月－ 2009 年12 月，收治18 例胫前皮肤软组织缺损患者。男12 例，女6 例；年龄7 ～ 58 岁，平均32.5 岁。车祸伤8 例，热压伤4 例，电击伤6 例。损伤部位：胫骨上段5 例，胫骨中下段13 例。创面缺损范围为3 cm × 3 cm ～ 15 cm × 8 cm。均伴胫骨外露。受伤至入院时间为1 h ～ 20 d，平均7 d。入院后10 例急诊、8 例二期行穿支血管筋膜蒂皮瓣修复术，皮瓣切取范围4 cm × 4 cm～ 16 cm × 9 cm。供区直接拉拢缝合或植皮修复。 结果 术后1 例出现皮瓣远端边缘坏死结痂，经换药愈合；其余皮瓣均顺利成活，创面Ⅰ期愈合。供区植皮均成活，切口Ⅰ期愈合。术后15 例获随访，随访时间6 ～ 12个月，平均10 个月。皮瓣色泽与正常皮肤相似，质地柔软，患肢外观及功能恢复较好。 结论 应用小腿穿支血管筋膜蒂皮瓣修复胫前皮肤软组织缺损创面，具有手术操作简便，皮瓣成活率高等优点。

胫前血管桥接游离股前外侧皮瓣修复小腿严重毁损伤

足背岛状动脉皮瓣修复小腿中下段软组织缺损

小腿复杂组织缺损的修复

目的 总结小腿复杂组织缺损的特点、修复的最佳时机与方法。 方法 2000 年1 月－ 2007 年12 月，收治小腿复杂组织缺损122 例。男102 例，女20 例；年龄7 ～ 65 岁，中位年龄31.5 岁。重物砸伤57 例，交通事故伤32 例，车轮绞伤3 例，其他伤30 例。缺损位于小腿上段28 例，中段37 例，下段57 例。皮肤缺损范围为10 cm ×5 cm ～ 20 cm × 11 cm。113 例伴骨、肌腱或钢板外露。病程4 h ～ 18 个月。术中采用吻合血管皮瓣19 例，带蒂皮瓣及筋膜皮瓣103 例，切取皮瓣大小为7 cm × 5 cm ～ 20 cm × 7 cm。骨缺损分别采用肢体缩短、髂骨植骨、吻合血管的腓骨及同侧腓骨植骨，骨移植长度3 ～ 16 cm。供区均用中厚皮片修复。 结果 术后119 例皮瓣成活，3 例皮瓣坏死，经对症处理后愈合。供区植皮均成活，切口愈合良好。术后98 例获随访，随访时间4 ～ 38 个月。12 例背阔肌皮瓣外观略显臃肿，未作处理；其他皮瓣质地良好。获随访的54 例骨缺损患者于术后8 ～ 18 个月达骨性愈合。 结论 小腿复杂组织缺损应根据组织缺损的具体情况，针对性选择皮瓣、适时对骨缺损进行修复与制动是手术成功的关键。

小腿远端蒂复合血管网皮瓣修复足踝部皮肤缺损

目的 探讨小腿远端蒂复合血管网皮瓣的血供特点及临床疗效。 方法 2004年2月～2005年12月，应用包含深筋膜、皮神经及浅静脉的小腿远端蒂复合血管网皮瓣修复足踝部皮肤缺损伴肌腱或骨外露创面16例，其中急诊修复6例，择期修复10例。男11例，女5例；年龄16～48岁。皮瓣切取范围9 cm×5 cm～17 cm×14 cm。 结果 术后16例皮瓣均成活，切口Ⅰ期愈合。患者均获随访1～8个月。皮瓣血循环良好，耐磨无破溃，有浅痛觉及触觉，两点辨别觉40～96 mm，受区臃肿不明显。供区创面Ⅰ期愈合。 结论 小腿远端蒂复合血管网皮瓣操作安全，成活率高，是修复足踝部皮肤缺损的一种有效方法。

The Repair of Lower Leg, Ankle and Foot Soft Tissue Defects

目的　评价不同皮瓣、肌皮瓣修复小腿及足踝部皮肤软组织缺损的效果，探讨小腿及足踝部皮肤软组织缺损的理想修复方法。 方法　2002年6月－2010年1月，应用15种皮瓣、肌皮瓣修复128例（138处）小腿及足踝部皮肤软组织缺损。其中小腿中上段21处，小腿中下段45处，内外踝及足跟部43处，足背及前足29处。主要应用最多的皮瓣有腓肠神经营养血管皮瓣、腓肠肌内外侧头肌皮瓣、腓浅神经营养血管皮瓣和足底内侧皮瓣。修复软组织缺损范围5 cm×4 cm～23 cm×14 cm。 结果　术后135处创面Ⅰ期愈合，皮瓣完全成活；2处皮瓣部分坏死，经二次手术植皮修复；1例游离股前外侧皮瓣修复小腿中下段软组织缺损，皮瓣完全坏死，后改取对侧腓肠神经营养血管交腿皮瓣修复成活。腓肠神经营养血管皮瓣应用例数最多，成活率高，吻合血管的游离皮瓣坏死率较高。术后患者均获随访1～10年，平均23个月，皮瓣均成活良好, 无溃疡、渗液等。 结论　正确认识并选择皮瓣、肌皮瓣修复小腿及足踝部皮肤软组织缺损可提高皮瓣成活率，恢复肢体良好功能，腓肠神经营养血管皮瓣是一种修复小腿及足踝部软组织缺损的理想皮瓣。

组合皮瓣一期修复小腿爆炸伤一例

CLINICAL APPLICATION OF THE UL-TRA LENGTH AND WIDTH RANDOM CALF FASCIOCUTANEOUS FLAP

The ultra length and width random calf fasciocutaneous flaps whose blood supply came from the calf fasciocutaneous vascular network were transposed in 9 cases for the treatment of severe trauma of leg. All of the flaps survived except one having necrosis of the distal fourth. The length and width of the flap to the width of the pedicle were 6.1∶1 and 2.7∶1 respectively. Properly extended the area and decreased of blood perfusion of the flan would reduce the burden of the venous backflow to the flap relatively. The abundant vascular networks of the calf fasciocutaneous flap was a very important factor that this type of flap would possibly survive.

Clinical application of Flow-through bridge anterolateral thigh flap in repair of complex calf soft tissue defects

Objective To investigate the effectiveness of Flow-through bridge anterolateral thigh flap transplantation in the treatment of complex calf soft tissue defects. Methods The clinical data of the patients with complicated calf soft tissue defects, who were treated with Flow-through bridge anterolateral thigh flap (study group, 23 cases) or bridge anterolateral thigh flap (control group, 23 cases) between January 2008 and January 2022, were retrospectively analyzed. All complex calf soft tissue defects in the two groups were caused by trauma or osteomyelitis, and there was only one major blood vessel in the calf or no blood vessel anastomosed with the grafted skin flap. There was no significant difference between the two groups in general data such as gender, age, etiology, size of leg soft tissue defect, and time from injury to operation (P>0.05). The lower extremity functional scale (LEFS) was used to evaluate the sufferred lower extremity function of the both groups after operation, and the peripheral blood circulation score of the healthy side was evaluated according to the Chinese Medical Association Hand Surgery Society’s functional evaluation standard for replantation of amputated limbs. Weber’s quantitative method was used to detect static 2-point discrimination (S2PD) to evaluate peripheral sensation of the healthy side, and the popliteal artery flow velocity, toenail capillary filling time, foot temperature, toe blood oxygen saturation of the healthy side, and the incidence of complications were compared between the two groups. Results No vascular or nerve injury occurred during operation. All flaps survived, and 1 case of partial flap necrosis occurred in both groups, which healed after free skin grafting. All patients were followed up 6 months to 8 years, with a median time of 26 months. The function of the sufferred limb of the two groups recovered satisfactorily, the blood supply of the flap was good, the texture was soft, and the appearance was fair. The incision in the donor site healed well with a linear scar, and the color of the skin graft area was similar. Only a rectangular scar could be seen in the skin donor area where have a satisfactory appearance. The blood supply of the distal limb of the healthy limb was good, and there was no obvious abnormality in color and skin temperature, and the blood supply of the limb was normal during activity. The popliteal artery flow velocity in the study group was significantly faster than that in the control group at 1 month after the pedicle was cut, and the foot temperature, toe blood oxygen saturation, S2PD, toenail capillary filling time, and peripheral blood circulation score were significantly better than those in the control group (P<0.05). There were 8 cases of cold feet and 2 cases of numbness on the healthy side in the control group, while only 3 cases of cold feet occurred in the study group. The incidence of complications in the study group (13.04%) was significantly lower than that in the control group (43.47%) (χ2=3.860, P=0.049). There was no significant difference in LEFS score between the two groups at 6 months after operation (P>0.05). ConclusionFlow-through bridge anterolateral thigh flap can reduce postoperative complications of healthy feet and reduce the impact of surgery on blood supply and sensation of healthy feet. It is an effective method for repairing complex calf soft tissue defects.