Park Chan Woo, Kim Youn Hwan, Hwang Kyu Tae, Kim Jeong Tae
Department of Plastic and Reconstructive Surgery, Hanyang University School of Medicine, Seoul, Korea.
Arch Plast Surg. 2012 Jul;39(4):417-21. doi: 10.5999/aps.2012.39.4.417. Epub 2012 Jul 13.
We present a case of a near total amputation at the distal tibial level, in which the patient emphatically wanted to save the leg. The anterior and posterior tibial nerves were intact, indicating a high possibility of sensory recovery after revascularization. The patient had open fractures at the tibia and fibula, but no bone shortening was performed. The posterior tibial vessels were reconstructed with an interposition saphenous vein graft from the contralateral side and a usable anterior tibial artery graft from the undamaged ipsilateral distal portions. The skin and soft tissue defects were covered using a subatmospheric pressure system for demarcating the wound, and a latissimus dorsi myocutaneous free flap for definite coverage of the wound. At 6 months after surgery, the patient was ambulatory without requiring additional procedures. Replantation without bone shortening, with use of vessel grafts and temporary coverage of the wound with subatmospheric pressure dressings before definite coverage, can shorten recovery time.
我们报告一例胫骨远端近乎完全离断的病例，该患者强烈希望保住这条腿。胫前神经和胫后神经完好无损，这表明血管重建后感觉恢复的可能性很大。患者胫腓骨开放性骨折，但未进行骨缩短术。采用对侧大隐静脉移植和同侧未受损远端可用的胫前动脉移植重建胫后血管。使用负压系统划定伤口范围，并采用背阔肌肌皮游离皮瓣明确覆盖伤口，以覆盖皮肤和软组织缺损。术后6个月，患者无需额外手术即可行走。不进行骨缩短的再植术，使用血管移植物，并在明确覆盖前用负压敷料临时覆盖伤口，可缩短恢复时间。
