Department of Orthopedics and Traumatology, UOD Reconstructive Microsurgery, CTO-M, Adelaide, Turin, Italy.
J Orthop Traumatol. 2011 Jun;12(2):93-9. doi: 10.1007/s10195-011-0136-0. Epub 2011 May 5.
Local flaps based on perforator vessels are raising interest in reconstructive surgery of the limbs. These flaps allow efficient coverage of large wounds without the need to sacrifice a major vascular axis. The operative technique does not require microvascular anastomosis and allows reconstruction of soft tissue defects using nearby similar tissues. The aim of this study was to evaluate the clinical results of local perforator flaps in the treatment of complex lower-limb defects.
Twenty-two local perforator flaps were retrospectively studied. Loss of substance was due to postsurgical complications in seven cases, oncological resection in six, posttraumatic defect in five, pressure sores in three, and osteomyelitis in one.
Postoperatively, two patients showed partial flap necrosis. In five patients, a superficial epidermolysis occurred. Minor complications were seen in three patients who showed transient venous congestion of the flap. Furthermore, transient leg edema was sometimes observed in patients with large propeller flaps. All but one patient healed without further major surgical procedures. In three cases, secondary skin grafts were performed. In most cases, the aesthetic result was optimal and patients were fully satisfied.
When characteristics of the defect are suitable for treatment with a propeller-based local flap, this technique should be considered as one of reasonable options for surgical reconstruction. Microsurgical techniques facilitate the management of complex trauma in emergency and may allow planning reconstructive procedures and limb salvage in elective orthopedic surgery.
基于穿支血管的局部皮瓣在四肢重建手术中引起了关注。这些皮瓣可在不牺牲主要血管轴的情况下，有效地覆盖大面积创伤。手术技术不需要进行微血管吻合，并且可以使用附近的相似组织来重建软组织缺损。本研究旨在评估局部穿支皮瓣治疗复杂下肢缺损的临床效果。
回顾性研究了 22 例局部穿支皮瓣。7 例因术后并发症、6 例因肿瘤切除、5 例因创伤后缺损、3 例因压疮、1 例因骨髓炎导致组织缺损。
术后 2 例患者出现部分皮瓣坏死，5 例患者出现浅表表皮松解。3 例患者出现短暂的皮瓣静脉淤血，有轻微并发症。此外，在使用大型螺旋桨皮瓣的患者中，有时会出现短暂的腿部肿胀。除 1 例外，所有患者均无需进一步进行主要手术治疗而愈合。3 例患者行二期植皮。在大多数情况下，美学效果是最佳的，患者完全满意。
当缺损的特点适合采用基于螺旋桨的局部皮瓣治疗时，该技术应被视为合理的手术重建选择之一。显微外科技术有助于处理急诊中的复杂创伤，并可能允许规划重建手术和择期骨科手术中的保肢治疗。
