Zeng Bingfang, Sui Shuping, Peizhu Jiang
Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Jiao Tong University, Shanghai, 200233, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2005 Jul;19(7):508-10.
To investigate the application of free flaps in combined transplantation and its clinical outcome.
From January 1991 to December 2003, 56 cases of combined transplantation involving cutaneous or myocutaneous flaps were performed to repair extremely large soft tissue defects, large-sized skin and segmental bone defects and to simultaneously reconstruct the missing thumb and repair the associated skin defects in the first web space. Of the 56 patients, 37 were males, 19 were females. Their ages ranged from 5 to 41, 27.6 in average. The transplants included latissimus dorsi myocutaneous flap, scapular flap, lateral femoral flap, big toe skin-nail flap, and fibula. To establish blood circulation in the transplants, the common vascular pedicle was anastomosed directly to the vessels in the recipient site in 35 cases but to the selected vessels in the healthy limb in 21 through a cross-bridge procedure. Results With failure in 2 cases of combined transplantation of latissimus dorsi myocutaneous flap and vascularized fibula, all the transplants survived well. In the 32 cases of long bone defects with successful repair, the transplanted fibula united with host bones 14.5 weeks after operation on the average. A mean follow-up of 28 (10-128) months revealed that function in all cases was recovered, while one patient, who underwent a successful combined transplantation of latissimus dorsi myocutaneous flap and vascularized fibula, required amputation of the involved leg 3 years after repair because of the repeated ulcers in the toes.
The application of free flaps in combined transplantation can lead to an effective repair of complicated tissue defects of the limb and to a successful reconstruction of the associated missing thumb.
探讨游离皮瓣在联合移植中的应用及其临床效果。
1991年1月至2003年12月，对56例涉及皮瓣或肌皮瓣的联合移植患者进行手术，修复巨大软组织缺损、大面积皮肤和节段性骨缺损，同时重建拇指缺失并修复第一掌骨间隙相关皮肤缺损。56例患者中，男性37例，女性19例。年龄5至41岁，平均27.6岁。移植组织包括背阔肌肌皮瓣、肩胛皮瓣、股外侧皮瓣、足拇趾甲皮瓣和腓骨。为使移植组织建立血运，35例将共同血管蒂直接吻合至受区血管，21例通过桥式手术将其吻合至健侧肢体选定血管。结果 背阔肌肌皮瓣与带血管蒂腓骨联合移植失败2例，其余移植组织均成活良好。32例长骨缺损修复成功，移植的腓骨平均于术后14.5周与宿主骨愈合。平均随访28（10 - 128）个月，所有病例功能均恢复，但1例背阔肌肌皮瓣与带血管蒂腓骨联合移植成功的患者，修复后3年因足趾反复溃疡而截肢。
游离皮瓣在联合移植中的应用可有效修复肢体复杂组织缺损，并成功重建相关的拇指缺失。
