Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
Microsurgery. 2011 Mar;31(3):241-5. doi: 10.1002/micr.20859. Epub 2011 Feb 23.
The prevailing treatment for distal third lower extremity defects is with autologous free tissue transfers. In the trauma patient, these reconstructions are wrought with challenges, including the selection of appropriate recipient vessels, avoiding the zone of injury, and choosing the appropriate flap for transfer, all while maintaining perfusion to the foot. With distal defects and a large zone of injury, the free flap pedicle may need additional length to cover the defect and reach the recipient vessels without excess tension. The creation of an arteriovenous loop from an autologous vein graft is the usual solution. We present a case where additional pedicle length was needed to have a free flap completely cover a distal leg defect and connect to the anterior tibial vessels proximally. The saphenous vein was not available as an interposition graft; therefore, the descending branch of the lateral femoral circumflex artery and venae comitantes were used as a composite arteriovenous interposition graft.
对于下肢远端三分之一处的缺损，目前主要采用游离组织移植进行治疗。在创伤患者中，这些重建手术面临着诸多挑战，包括选择合适的受区血管、避免损伤区以及选择合适的皮瓣进行转移，同时还要保持足部的血液灌注。对于远端缺损和较大的损伤区，游离皮瓣的蒂部可能需要额外的长度来覆盖缺损并到达受区血管，而不会产生过度张力。通常的解决方法是使用自体静脉移植来建立动静脉环。我们报告了一个病例，为了使游离皮瓣完全覆盖小腿远端的缺损并与胫前血管近端连接，需要增加蒂部的长度。大隐静脉不能作为中间移植物；因此，使用旋股外侧动脉降支及其伴行静脉作为复合动静脉中间移植物。
