Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany.
J Reconstr Microsurg. 2010 Jul;26(5):291-4. doi: 10.1055/s-0030-1248239. Epub 2010 Feb 8.
In situations of bony nonunions with poor skin coverage, transplantation of vascularized soft tissue in addition to bone graft is desirable. The use of the corticoperiosteal vascularized bone graft from the medial femoral condyle is well described. There are only anecdotal reports about its use as an osteocutaneous flap. This article presents our results with the use of an osteocutaneous flap from the medial femoral condyle. Between 2004 and 2009, four patients were treated with supracondylar osteocutaneous flaps for bony nonunions (tibia, ankle, calcaneous) with concomitant soft tissue defects. The size of the osseous grafts ranged from 3 x 5 to 6 x 5 cm. The supplying cutaneous vessels were an unnamed perforator of the descending genicular artery (two cases) or the saphenous branch (two cases). The first three cases healed primarily. Bony union was achieved between 32 and 170 days. The follow-up of the fourth case was too short to achieve a bony union. There was no flap loss or surgery-related complications at the donor site. The transfer of free combined vascularized corticoperiosteal-cutaneous flaps seems to be ideally suited for postradiation-induced fractures or chronic nonunions with poor chances of spontaneous healing and a concomitant small skin defect.
在伴有皮肤覆盖不良的骨不连情况下，除了骨移植外，还需要移植带血管的软组织。使用来自股骨内侧髁的带血管皮质骨-骨膜移植已经得到了很好的描述。只有一些关于将其用作骨-皮瓣的零星报道。本文介绍了我们使用股骨内侧髁的骨-皮瓣的结果。2004 年至 2009 年间，4 名患者因伴有软组织缺损的骨不连（胫骨、踝关节、跟骨）接受了髁上骨-皮瓣治疗。骨移植物的大小从 3x5 到 6x5cm 不等。供应的皮肤血管是来自膝降动脉的无名穿支（两例）或隐动脉分支（两例）。前三例均一期愈合。骨愈合时间为 32-170 天。第四例的随访时间太短，无法达到骨性愈合。供区无皮瓣丢失或与手术相关的并发症。游离复合带血管皮质骨-皮瓣的转移似乎非常适合放射后引起的骨折或伴有自发性愈合机会低和伴随小皮肤缺损的慢性骨不连。
