Liu Jun, Song Dajiang, Li Jinsong, Xu Jian, Lv Hongbin
Department of Sports Medicine, Xiangya Hospital of Central South University , Changsha , PR China.
J Plast Surg Hand Surg. 2015 Apr;49(2):102-6. doi: 10.3109/2000656X.2014.922979. Epub 2014 Jul 8.
The paper aims to improve the operative technique of osteomyocutaneous iliac crest flap harvesting, further minimise morbidity of donor site, and improve the effect of recipient site reconstruction. From March 2005 to March 2011, 55 cases of osteomyocutaneous iliac crest flap harvested by different methods were performed to reconstruct the defects of the extremities. Twenty-nine cases were reconstructed with a traditional deep circumflex iliac artery osteomusculocutaneous flap. Twenty-six cases were repaired with modified osteomyocutaneous iliac crest flaps. In 29 cases with a traditional DCIA osteomusculocutaneous flap, two cases showed the injured lateral femoral cutaneous nerve. Flapnecrosis was significant in two cases. Arterial compromise occurred in one case 5 days after operation completion and led to flap failure. Three flaps developed postoperative venous congestion, but only one flap received re-exploration. In the other two cases, some stitches were removed for decompression. All three flaps survived. In two cases, marginal flap necrosis occurred, but no secondary skin grafting was required. In 26 cases with modified flap transplantation, one case showed the injured lateral femoral cutaneous nerve. All flaps survived totally. Osseous integration was achieved in all 55 cases in 3 ∼ 9 months after operation. The modified osteomyocutaneous iliac crest flap technique enhances flap safety, provides the additional advantages of reducing donor-site morbidity, and improves the recipient-site contour.
本文旨在改进髂骨肌皮瓣切取的手术技术，进一步降低供区并发症，并提高受区重建效果。2005年3月至2011年3月，对55例采用不同方法切取髂骨肌皮瓣重建肢体缺损的患者进行了研究。其中29例采用传统的旋髂深动脉骨肌皮瓣进行重建，26例采用改良髂骨肌皮瓣进行修复。在29例采用传统旋髂深动脉骨肌皮瓣的患者中，2例出现股外侧皮神经损伤，2例皮瓣坏死明显，1例术后5天出现动脉供血障碍导致皮瓣坏死，3例皮瓣术后出现静脉淤血，仅1例进行了再次探查，另外2例拆除部分缝线减压，3例皮瓣均存活。2例出现皮瓣边缘坏死，但均无需二期植皮。在26例采用改良皮瓣移植的患者中，1例出现股外侧皮神经损伤，所有皮瓣均完全存活。55例患者术后3～9个月均实现了骨整合。改良髂骨肌皮瓣技术提高了皮瓣安全性，具有降低供区并发症的额外优势，并改善了受区外形。
