Pu Lee L Q
Division of Plastic Surgery, University of Kentucky College of Medicine, Lexington, Kentucky 40536, USA.
Int Surg. 2006 Jul-Aug;91(4):194-200.
Although the medial hemisoleus muscle has been considered a local reconstructive option for soft-tissue reconstruction of the middle-third tibial wound, its reliability and usefulness has been debated among plastic surgeons. This study reports one surgeon's experience with medial hemisoleus muscle flaps and shows their application for soft tissue reconstruction of middle-third tibial wounds. Over the past 2 years, 10 patients underwent soft tissue reconstruction of a middle-third tibial wound with a medial hemisoleus muscle flap and skin graft. The flap was elevated with emphasis on the preservation of as many perforators to the flap as possible while allowing adequate arch rotation of the flap to cover the exposed tibia and/or hardware. All patients were followed for up to 2 years. There was no total flap loss, and limb salvage was achieved in every patient in this series. Only two patients with peripheral vascular disease developed small partial but insignificant distal flap necrosis and were treated with debridement and flap advancement. The tibial wounds of all patients subsequently healed with excellent cosmetic outcome during follow-up. The results from this study indicate that the medial hemisoleus muscle flap is reliable for soft-tissue reconstruction of a middle-third tibial wound. Meticulous flap elevation with the preservation of perforators to the flap is the key for such success.
尽管内侧半比目鱼肌已被视为胫骨中1/3伤口软组织重建的局部重建选择，但整形外科医生对其可靠性和实用性一直存在争议。本研究报告了一位外科医生使用内侧半比目鱼肌皮瓣的经验，并展示了其在胫骨中1/3伤口软组织重建中的应用。在过去2年中，10例患者接受了内侧半比目鱼肌皮瓣联合皮肤移植的胫骨中1/3伤口软组织重建。皮瓣掀起时强调尽可能保留皮瓣的穿支，同时允许皮瓣进行充分的弧形旋转以覆盖暴露的胫骨和/或内固定物。所有患者均随访2年。本系列中无一例皮瓣完全坏死，所有患者均成功保肢。仅2例患有周围血管疾病的患者出现小面积的远端皮瓣部分坏死，但不严重，经清创和皮瓣推进治疗。所有患者的胫骨伤口在随访期间均愈合良好，美容效果极佳。本研究结果表明，内侧半比目鱼肌皮瓣在胫骨中1/3伤口软组织重建中是可靠的。精心掀起皮瓣并保留皮瓣穿支是取得这种成功的关键。
