旋股外侧动脉降支嵌合穿支皮瓣游离移植治疗胫骨创伤后骨髓炎

Free transplantation of chimeric perforator flap based on descending branch of lateral circumflex femoral artery for treatment of traumatic tibial osteomyelitis

摘要:

目的  总结旋股外侧动脉降支嵌合穿支皮瓣游离移植治疗胫骨创伤后骨髓炎的临床经验。方法  2014年8月-2015年9月，8例胫骨创伤后骨髓炎在彻底清创后采用旋股外侧动脉降支嵌合穿支皮瓣游离移植修复，股外侧肌瓣填塞胫骨死腔，穿支皮瓣覆盖浅表创面。结果  8例皮瓣全部顺利成活，其中，1例术后感染经换药治疗愈合，其余7例创口一期愈合。术后随访6～18个月，胫骨骨髓炎无复发，皮瓣色泽、质地好，皮瓣供区直接缝合，仅遗留线性瘢痕。结论  旋股外侧动脉降支嵌合穿支皮瓣肌瓣血运好且与皮瓣仅以穿支血管相连拥有足够自由度，可以实现创面立体修复，是一种治疗胫骨创伤后骨髓炎的有效方法。

Abstract:

Objective To conclude the clinical experiences of treating traumatic tibial osteomyelitis with free chimeric perforator flap based on the descending branch of the lateral circumflex femoral artery. Methods From August 2014 to September 2015, 8 cases of traumatic tibial osteomyelitis were treated with free chimeric perforator flap based on the descending branch of the lateral circumflex femoral artery, the perforator connected perforator flap and muscle flap, the muscle flap was used to fill in the deep dead space, the perforator flap was used to cover the superficial wound. The descending branch of the lateral circumflex femoral artery and its concomitant veins were anastomosed with posterior (or anterior) tibial artery and its concomitant veins. Results All patients were successfully treated with the chimeric perforator flap without major compli-cations. Infection occurred in one case but was healed by dressing change. Postoperative follow-up of 6 - 18 months was achieved, and no recurrence of osteomyelitis of the tibia was found, and satisfactory color and texture of the flap were obtained. Primary donor-site closure was achieved in all cases, only a linear scar was left at the donor-site. Conclusions Free chimeric perforator flap based on the descending branch of the lateral circumflex femoral artery is an effective method to treat traumatic tibial osteomyelitis.