Redett R J, Robertson B C, Chang B, Girotto J, Vaughan T
Department of Surgery, the Johns Hopkins School of Medicine, Baltimore, MD, USA.
Plast Reconstr Surg. 2000 Dec;106(7):1507-13. doi: 10.1097/00006534-200012000-00010.
An extensive series reviewing the benefits and drawbacks of use of the gracilis muscle in lower-extremity trauma has not previously been collected. In this series of 50 patients, the use of microvascular free transfer of the gracilis muscle for lower-extremity salvage in acute traumatic wounds and posttraumatic chronic wounds is reviewed. In addition, the wound size, injury patterns, problems, and results unique to the use of the gracilis as a donor muscle for lower-extremity reconstruction are identified. In a 7-year period from 1991 to 1998, 50 patients underwent lower-extremity reconstruction using microvascular free gracilis transfer at the University of Maryland Shock Trauma Center, Johns Hopkins Hospital, and Johns Hopkins Bayview Medical Center. There were 22 patients who underwent reconstruction for coverage of acute lower-extremity traumatic soft-tissue defects associated with open fractures. The majority of patients were victims of high-energy injuries with 91 percent involving motor vehicle or motorcycle accidents, gunshot wounds, or pedestrians struck by vehicles. Ninety-one percent of the injuries were Gustilo type IIIb tibial fractures and 9 percent were Gustilo type IIIc. The mean soft-tissue defect size was 92.2 cm2. Successful limb salvage was achieved in 95 percent of patients. Twenty-eight patients with previous Gustilo type IIIb tibia-fibula fractures presented with posttraumatic chronic wounds characterized by osteomyelitis or deep soft-tissue infection. Successful free-tissue transfer was accomplished in 26 of 28 patients (93 percent). All but one of the patients in this group who underwent successful limb salvage (26 of 27, or 96 percent) are now free of infection. Use of the gracilis muscle as a free-tissue transfer has been shown to be a reliable and predictable tool in lower-extremity reconstruction, with a flap success and limb salvage rate comparable to those in other large studies.
此前尚未收集过全面回顾在下肢创伤中使用股薄肌的利弊的系列研究。在这组50例患者中，回顾了采用股薄肌微血管游离移植来挽救急性创伤伤口和创伤后慢性伤口所致下肢功能的情况。此外，还确定了将股薄肌用作下肢重建供肌所特有的伤口大小、损伤模式、问题及结果。在1991年至1998年的7年期间，50例患者在马里兰大学休克创伤中心、约翰霍普金斯医院和约翰霍普金斯湾景医疗中心接受了股薄肌微血管游离移植的下肢重建手术。有22例患者接受重建手术以覆盖与开放性骨折相关的急性下肢创伤性软组织缺损。大多数患者是高能损伤的受害者，91%的损伤涉及机动车或摩托车事故、枪伤或行人被车辆撞击。91%的损伤为 Gustilo IIIb型胫骨骨折，9%为 Gustilo IIIc型。平均软组织缺损面积为92.2平方厘米。95%的患者成功保肢。28例既往有 Gustilo IIIb型胫腓骨骨折的患者出现以骨髓炎或深部软组织感染为特征的创伤后慢性伤口。28例患者中有26例（93%）成功完成了游离组织移植。该组中除1例患者外，所有成功保肢的患者（27例中的26例，即96%）目前均无感染。已证明将股薄肌用作游离组织移植是下肢重建中一种可靠且可预测的方法，皮瓣成功率和保肢率与其他大型研究相当。
