Lin Chih-Hung, Lin Yu-Te, Yeh Jiun-Ting, Chen Chien-Tzung
Taipei, Taiwan From the Division of Trauma, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University.
Plast Reconstr Surg. 2007 Jun;119(7):2118-2126. doi: 10.1097/01.prs.0000260595.85557.41.
Traumatized lower extremities may present not only composite soft-tissue defects but also flexor and/or extensor loss. Free functioning muscle transfer can provide composite structural and functional restoration.
From 1996 to 2004, 19 patients with lower extremity injuries whose lesions exhibited composite soft-tissue damage, with or without bone defects, and certain accompanying functional disabilities were allocated to study groups on the basis of impression, as follows: group I, open fracture IIIB (n = 10); group II, neglected compartment syndromes [open IIIB (n = 4) and open IIIC (n = 1)]; and group III, crush injuries (n = 4). Free flap resurfacing was indicated for these lesions. Fifteen patients underwent free functioning muscle transfer; source muscles were the rectus femoris (n = 3), rectus femoris with anterolateral thigh flap (n = 5), and gracilis (for ankle dorsiflexion) (n = 7). Two patients underwent composite rectus femoris and vascular iliac crest for ankle dorsiflexion and segmental tibial defect reconstruction. Two received rectus femoris muscle and anterolateral thigh flaps for posterior compartment defect and quadriceps defect reconstruction, individually.
Two patients required reexploration; salvage was successful in only one, with below-knee amputation necessary in the other. Skin grafts were needed for partial skin paddle necrosis (n = 3) or remaining skin defect (n = 2). Functioning muscle reinnervation failed in four cases, with one individual undergoing ankle fusion, two people electing ambulation with stiff ankles, and one person using an orthosis. In the sample population, range of motion varied and was related to the severity of injury and the extent of skin grafting on the distal musculotendinous portion. Less function was exhibited in the compartment syndrome group (group II).
Functioning muscle transfer can be performed posttraumatically in lower limbs with composite soft-tissue and motor-unit defects, resulting in acceptable functional results and reliable limb salvage.
创伤后的下肢不仅可能出现复合性软组织缺损，还可能出现屈肌和/或伸肌功能丧失。带功能的游离肌肉移植可实现复合结构和功能的重建。
1996年至2004年，19例下肢损伤患者，其损伤表现为复合性软组织损伤，伴有或不伴有骨缺损，并伴有一定的功能障碍，根据印象分为研究组，如下：I组，开放性III B型骨折（n = 10）；II组，漏诊的骨筋膜室综合征[开放性III B型（n = 4）和开放性III C型（n = 1）]；III组，挤压伤（n = 4）。这些损伤均需游离皮瓣覆盖。15例患者接受了带功能的游离肌肉移植；供肌为股直肌（n = 3）、股直肌联合股前外侧皮瓣（n = 5）、股薄肌（用于踝关节背伸）（n = 7）。2例患者接受股直肌联合血管化髂嵴移植用于踝关节背伸和胫骨节段性缺损重建。2例分别接受股直肌和股前外侧皮瓣用于后骨筋膜室缺损和股四头肌缺损重建。
2例患者需要再次探查；仅1例挽救成功，另1例需要行膝下截肢。部分皮瓣坏死（n = 3）或剩余皮肤缺损（n = 2）需要植皮。4例带功能的肌肉再支配失败，其中1例行踝关节融合，2例选择踝关节僵硬行走，1例使用矫形器。在样本人群中，活动范围各不相同，与损伤严重程度及远端肌腱部分的植皮范围有关。骨筋膜室综合征组（II组）功能较差。
对于伴有复合性软组织和运动单位缺损的下肢创伤后患者，可进行带功能的肌肉移植，能获得可接受的功能结果并可靠地挽救肢体。
