Erne H, Schmauss D, Schmauss V, Ehrl D
Department for Plastic Surgery, Hand Surgery and Reconstructive Microsurgery, BG Trauma Center Murnau am Staffelsee, Germany; Department for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
Department for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, Germany.
Injury. 2016 Jun;47(6):1288-92. doi: 10.1016/j.injury.2016.02.017. Epub 2016 Mar 3.
The distally based peroneus brevis muscle flap is a valuable therapeutic option for coverage of tissue defects around the ankle and the distal lower leg. However, the rate of postoperative flap complications requiring revisional surgery is high due to an impaired venous drainage and oedema formation. The purpose of this study was to evaluate if postoperative negative pressure therapy is able to reduce flap complications.
From April 2010 until March 2014, we treated 74 patients with distally based peroneus brevis muscle flaps for defect coverage at the lower leg. In four cases, an osteomuscular composite flap has been used to treat partly stability-relevant bone defects. In 43 cases, negative pressure therapy (75mmHg, continuous) with a circular dressing was initiated after the flap procedure for 7 days. In 31 cases no negative pressure therapy was initiated. We retrospectively analysed those two groups of patients. The primary endpoint was the incidence of flap complications with a need for revision surgery, which were classified in three grades.
The group treated with negative pressure therapy had significantly less flap complications when compared to the control group (p<0.0001). Concerning the single grades of complication, the negative pressure therapy-group had a significantly smaller rate of skin graft necrosis (Grade 1; p=0.014) and partial flap loss (Grade 2; p=0.002) compared to the control group. There were no statistically significant differences concerning complete flap loss (Grade 3) between both groups.
Postoperative negative pressure therapy for 7 days reduces flap complications in distally based peroneus brevis flaps.
以远侧为蒂的腓骨短肌肌瓣是覆盖踝关节和小腿远端周围组织缺损的一种有价值的治疗选择。然而，由于静脉引流受损和水肿形成，需要进行翻修手术的术后皮瓣并发症发生率很高。本研究的目的是评估术后负压治疗是否能够减少皮瓣并发症。
从2010年4月至2014年3月，我们治疗了74例采用以远侧为蒂的腓骨短肌肌瓣覆盖小腿缺损的患者。在4例患者中，采用了骨肌复合瓣来治疗部分与稳定性相关的骨缺损。在43例患者中，皮瓣手术后开始使用圆形敷料进行负压治疗（75mmHg，持续）7天。在31例患者中未开始进行负压治疗。我们对这两组患者进行了回顾性分析。主要终点是需要翻修手术的皮瓣并发症发生率，并发症分为三个等级。
与对照组相比，接受负压治疗的组皮瓣并发症明显更少（p<0.0001）。关于单个并发症等级，与对照组相比，负压治疗组的皮肤移植坏死率（1级；p=0.014）和部分皮瓣丢失率（2级；p=0.002）明显更低。两组之间在完全皮瓣丢失（3级）方面没有统计学上的显著差异。
术后进行7天的负压治疗可减少以远侧为蒂的腓骨短肌皮瓣的并发症。
