Chen Aimin, Hou Chunlin, Zhao Yuezhong
Department of Orthopaedic, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2005 Jul;19(7):541-3.
To design a combined flap of subscapular axis including vascularized lateral scapular, rib and latissimus dorsi to repair the large defect of tibia.
The patient was a 39-year-old man who got a posttraumatic 12 cm defect of tibia after primary debridement and external fixation because of open fracture 5 months ago. There was a 12 cm x 6 cm scar involved the proximal medial segment of tibia. After resection of scar and fibular tissue over the bone defect floor, a latissimus dorsi myocutaneous flap 14 cm x 5 cm pedicled with subscapular artery-thoracodorsal artery, a flap 12.5 cm on the outside of the scapular pedicled with thoracodorsal artery, and 6th rib flap 13 cm by serratus were prepared. The tibialis posterior and saphenous vein were used for anastomosis. A proximal anatomic plate was applied to the fixation of tibia.
The compound flap survived the operation. The follow-up period was 2 years. Bone union occurred 6 months after operation.
This combined flap is successful and can provide alternative to the resolution of large defect of tibia.
设计一种包含带血管蒂的肩胛外侧、肋骨和背阔肌的肩胛下轴组合皮瓣，用于修复胫骨大段骨缺损。
患者为一名39岁男性，5个月前因开放性骨折行一期清创及外固定后，遗留创伤后胫骨12 cm骨缺损。胫骨近端内侧段有一条12 cm×6 cm的瘢痕。切除骨缺损处的瘢痕及腓骨组织后，制备以肩胛下动脉-胸背动脉为蒂的14 cm×5 cm背阔肌肌皮瓣、以胸背动脉为蒂的肩胛外侧12.5 cm皮瓣以及以锯肌为蒂的第6肋皮瓣。采用胫后血管及大隐静脉进行吻合。应用近端解剖钢板固定胫骨。
复合皮瓣术后成活。随访2年。术后6个月骨愈合。
该组合皮瓣手术成功，可为解决胫骨大段骨缺损提供一种选择。
