Nenad Tajsi, Reiner Winkel, Michael Schlageter, Reinhard Hoffmann, Hans Husum
Institute of Clinical Medicine, Tromsoe University, Tromsø, Norway.
J Trauma. 2010 May;68(5):1200-7. doi: 10.1097/TA.0b013e3181d03d18.
The management strategies for reconstruction of soft-tissue defects of the lower leg and the foot remain disputed. To date, no comprehensive studies have been reported on the saphenous perforator flaps in reconstructive surgery in patients with posttraumatic osteomyelitis.
Fifty patients with lower leg postinjury chronic osteomyelitis were included in a retrospective, noncontrolled clinical study conducted from 1995 to 2006. All study patients were managed by distally based saphenous neurofasciocutaneous perforator flaps, the feeding perforators originating from the tibial artery. An endpoint survey was conducted after flap surgery, mean follow-up period 4 years, response rate 60%.
Six patients had short-term flap failure (12%, 95% confidence interval: 5-24). An additional six patients had flap necrosis of <(1/4) that healed without surgical revision. Based on the endpoint data, the long-term success rate was 70% (95% confidence interval: 51-85). Three variables had impact on flap failure rates: the number of previous reconstructive operations, the identity of the performing surgeon, and the area of the primary defect. Other assumed risk factors had no statistically significant impact on short- or long-term results. The anatomic localization of the perforating arteries is described.
The saphenous perforator flap is a sturdy flap with low short-term failure rates, also in high-risk patients. The success rate compares well with results of free flap transfers in the management of posttraumatic osteomyelitis. The saphenous flap is a feasible option for posttraumatic reconstructions of osteomyelitis, especially in low-resource settings.
小腿和足部软组织缺损的重建管理策略仍存在争议。迄今为止，尚未有关于创伤后骨髓炎患者重建手术中隐静脉穿支皮瓣的综合研究报道。
1995年至2006年进行了一项回顾性、非对照临床研究，纳入了50例小腿创伤后慢性骨髓炎患者。所有研究患者均采用远端蒂隐神经筋膜皮穿支皮瓣进行治疗，供血穿支源自胫动脉。皮瓣手术后进行了终点调查，平均随访期4年，应答率60%。
6例患者出现短期皮瓣失败（12%，95%置信区间：5%-24%）。另外6例患者皮瓣坏死面积<(1/4)，未经手术修复即愈合。根据终点数据，长期成功率为70%（95%置信区间：51%-85%）。有三个变量对皮瓣失败率有影响：既往重建手术的次数、主刀医生的身份以及原发缺损的面积。其他假定的危险因素对短期或长期结果无统计学显著影响。描述了穿支动脉的解剖定位。
隐静脉穿支皮瓣是一种坚固的皮瓣，短期失败率低，高危患者亦是如此。在创伤后骨髓炎的治疗中，其成功率与游离皮瓣移植的结果相当。隐静脉皮瓣是创伤后骨髓炎重建的可行选择，尤其是在资源匮乏的环境中。
