Jeng S F, Kuo Y R, Wei F C, Wang J W, Chen S H
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung University, Taiwan.
Ann Plast Surg. 2001 Jul;47(1):47-52. doi: 10.1097/00000637-200107000-00009.
Three patients with compound injuries of the lower extremities were treated with pedicle fibular grafts and a free muscle flap concomitantly. There were 1 female and 2 male patients, all of whom sustained high-energy trauma in a motor vehicle accident. The bone defect of the tibia ranged from 8 to 12 cm. The size of the soft-tissue defect ranged from 24 x 15 cm to 28 x 15 cm. All patients underwent preoperative angiography to ensure the patency of the peroneal artery and to avoid its use by risking viability of the leg. All patients were treated with an antegrade-flow pedicle fibular graft. The fibular graft was inserted as a single strut in 2 patients and as a double-barrel strut in 1 patient. The pedicle of the free muscle flap was anastomosed to the distal runoff of the fibular bone flap. All free muscle flap transfers succeeded without complication. Bone scans performed on postoperative day 7 showed viability of transferred bone. The average time to radiological union was 9 months, and the average time to full weight bearing was 12 months. Screw loosening occurred in 2 patients and osteomyelitis was noted in another patient who was treated successfully with sequestrectomy and antibiotics. Indications for this technique are a large segmental bone defect with a huge soft-tissue defect, and patency of the peroneal artery and at least one other major artery. This method provides the advantages of one-stage reconstruction, avoidance of contralateral donor site morbidity, easy control of infection, and chance for early weight bearing. When selected carefully, this technique can be considered when one wants to avoid a two-stage, two free flap transfer.
3例下肢复合伤患者接受了带蒂腓骨移植并同时进行游离肌皮瓣移植治疗。其中女性1例，男性2例，均在机动车事故中遭受高能创伤。胫骨骨缺损范围为8至12厘米。软组织缺损大小范围为24×15厘米至28×15厘米。所有患者术前行血管造影，以确保腓动脉通畅，并避免因使用该动脉而危及下肢存活。所有患者均采用顺行血流带蒂腓骨移植。2例患者将腓骨移植作为单支柱植入，1例患者作为双筒支柱植入。游离肌皮瓣的蒂与腓骨骨瓣的远端流出道吻合。所有游离肌皮瓣转移均成功，无并发症。术后第7天进行的骨扫描显示移植骨存活。放射学骨愈合的平均时间为9个月，完全负重的平均时间为12个月。2例患者出现螺钉松动，另1例患者发生骨髓炎，经死骨切除和抗生素治疗成功。该技术的适应证为大段骨缺损伴巨大软组织缺损，腓动脉通畅且至少有一条其他主要动脉通畅。该方法具有一期重建、避免对侧供区并发症、易于控制感染和早期负重机会等优点。经仔细选择，当希望避免两期、两次游离皮瓣转移时可考虑采用该技术。
