Hallock G G
Division of Plastic Surgery, Allentown Hospital, Pennsylvania.
J Trauma. 1989 Sep;29(9):1240-4. doi: 10.1097/00005373-198909000-00009.
Severe lower extremity trauma frequently results in a soft-tissue deficit that mandates wound coverage using some form of vascularized flap. The recent rediscovery of inclusion of the deep fascia during elevation of random skin flaps has enhanced the viability of large local flaps as a reconstructive option in the lower leg. In selected cases of relatively uncontaminated, moderate-sized defects, the choice of this maneuver has permitted closure of many defects which previously might have required a complex microsurgical tissue transfer. This series of 41 random-based local fasciocutaneous flaps in the lower leg in 38 patients has in all cases except two been successful in achieving preferred wound healing. Flap necrosis occurred only in these two cases presumably due to peripheral vascular insufficiency necessitating limb amputation in one patient. Eight (19%) had some form of complication, most occurring in the subset of flaps used for distal third lower leg wounds. The fasciocutaneous flap is conceptually simple, rapidly elevated and inset, and minimizes the region of surgical insult for many multitrauma patients who otherwise might have to forego any attempt for limb salvage.
严重的下肢创伤常常导致软组织缺损，这就需要采用某种形式的带血管蒂皮瓣来覆盖创面。近期重新发现，在随意皮瓣掀起过程中包含深筋膜可提高大型局部皮瓣的存活能力，使其成为小腿重建的一种选择。在一些相对清洁、中等大小缺损的特定病例中，采用这种方法能够闭合许多以往可能需要复杂显微外科组织移植才能闭合的创面。本系列研究对38例患者的小腿进行了41例随意型局部筋膜皮瓣手术，除2例之外，所有病例均成功实现了理想的创面愈合。仅这2例发生了皮瓣坏死，推测其中1例是由于外周血管功能不全而不得不截肢。8例（19%）出现了某种形式的并发症，大多数发生在用于小腿远端三分之一创面的皮瓣亚组中。筋膜皮瓣在概念上简单，掀起和植入迅速，对于许多多发伤患者而言，它将手术损伤区域降至最低，否则这些患者可能不得不放弃任何保肢尝试。
