Hankiss J, Schmitz C
Klinik für Plastische, Ästhetische und Handchirurgie, Klinikum Lippe GmbH, Rintelner Str. 85, 32657, Lemgo, Deutschland.
Oper Orthop Traumatol. 2013 Apr;25(2):145-51. doi: 10.1007/s00064-012-0197-0.
Defect coverage especially in exposed bone of the lower leg by pedicled muscle flaps in association with a split-thickness skin graft. Defect coverage oropharyngeal or at the upper extremity by free soleus flaps.
Defects of the proximal and middle thirds of the anterior lower leg for the proximally pedicled soleus flap; defects of the middle and distal third of the anterior lower leg for the distally pedicled soleus flap. The free flap is almost ubiquitously useable.
Primary diseases that makes a 2-h operation impossible, relevant affection of supplying vessels (the posterior tibial artery and/or the peroneal artery). Inadequate perfusion of the lower leg due to angiopathy, extensive soft-tissue infection, and wound contamination.
Medial, longitudinal incision, slightly posterior to the tibia, according to the desired flap elevation (distally or proximally pedicled). Preparation of relevant vessels, mobilization of the muscle and transposition into local defects or use as a free graft. The pedicled flaps usually need a split-thickness skin graft to cover.
Close monitoring of blood flow, temperature and swelling situation (hourly). Pressure-free wound-dressing of the leg, no circular or constricting dressings. Bedrest for 10 days, then start of flap training with intermittent circular compression, thrombosis prophylaxis, nicotine abstinence, physiotherapy, which depends on the bony situation, compression stocking after 3 weeks.
Reliable results achieved at the middle and distal lower leg.
采用带蒂肌皮瓣联合中厚皮片覆盖小腿尤其是暴露骨质的缺损。采用游离比目鱼肌皮瓣覆盖口咽或上肢的缺损。
近端蒂比目鱼肌皮瓣用于小腿前侧近端和中段三分之一的缺损；远端蒂比目鱼肌皮瓣用于小腿前侧中段和远端三分之一的缺损。游离皮瓣几乎可用于任何部位。
导致无法进行2小时手术的原发性疾病、供血血管（胫后动脉和/或腓动脉）的相关病变。因血管病变导致小腿灌注不足、广泛软组织感染和伤口污染。
根据所需皮瓣提升方向（远端蒂或近端蒂），在胫骨稍后方做内侧纵向切口。准备相关血管，游离肌肉并转移至局部缺损处或用作游离移植。带蒂皮瓣通常需要中厚皮片覆盖。
密切监测血流、温度和肿胀情况（每小时一次）。小腿伤口采用无压力包扎，避免环形或压迫性包扎。卧床休息10天，然后开始皮瓣训练，包括间歇性环形加压、预防血栓形成、戒烟、物理治疗（取决于骨质情况），3周后使用弹力袜。
小腿中下段取得可靠疗效。
