Blanc C, Kerfant N, Robert M, Gasnier P, Hu W
Service de chirurgie plastique, reconstructrice et esthétique, CHU La Cavale Blanche, boulevard Tanguy-Prigent, 29200 Brest, France.
Ann Chir Plast Esthet. 2015 Apr;60(2):153-9. doi: 10.1016/j.anplas.2014.07.019. Epub 2014 Aug 26.
We present the case of a forearm functional reconstruction of composite fibula free flap. This is a complex forearm trauma by crushing in a 24-year-old patient. The assessment of the lesions showed a bone defect of 15cm radial and ulnar diaphysis, a muscular defect of the posterior compartment of the forearm and a large skin defect next. The radial pedicle was also injured.
At 48hours, we conducted a reconstruction by free fibular flap and soleus muscle. The fibula osteosynthesys was performed between the proximal ulna and radius distally. The nerve of the soleus muscle was anastomosed to a branch of the posterior interosseous nerve and tendons of the extensor muscles of the wrist and fingers were sutured to the distal portion of the transferred muscle.
At 6 months, bone healing is achieved. Soleus muscle contracts and the strength of the extensor muscles of the fingers and wrist has been listed 4. Joint amplitudes of -20°/75° for the wrist, complete for the long fingers and the elbow. The aftermath of the donor site is minimal.
Reconstruction by free fibular flap and reinnervated soleus muscle is often cited in the literature but few cases are described. It is for us, the best therapeutic solution for this type of injury. It restores muscle function satisfactorily all ensuring high quality coverage defect of the forearm.
我们介绍一例游离腓骨复合组织瓣进行前臂功能重建的病例。这是一名24岁患者因挤压导致的复杂前臂创伤。损伤评估显示桡骨和尺骨干有15厘米的骨缺损，前臂后骨筋膜室有肌肉缺损，接下来还有大面积皮肤缺损。桡侧血管蒂也受损。
在48小时时，我们采用游离腓骨瓣和比目鱼肌进行重建。在近端尺骨和远端桡骨之间进行腓骨骨内固定。将比目鱼肌的神经与骨间后神经的一个分支进行吻合，并将腕和手指伸肌的肌腱缝合到转移肌肉的远端部分。
6个月时，骨愈合完成。比目鱼肌收缩，手指和腕部伸肌的力量评级为4级。腕关节活动度为-20°/75°，长手指和肘关节活动度正常。供区后遗症极小。
游离腓骨瓣和再神经化比目鱼肌重建在文献中经常被提及，但描述的病例很少。对我们来说，这是这类损伤的最佳治疗方案。它能令人满意地恢复肌肉功能，同时确保前臂缺损得到高质量覆盖。
