Guo Jia, Liu Yong, Liu Xiaohui, Sui Zhiqiang, Zhang Xuetao, Wang Lei
Department of Surgery, Weifang Medical University, Weifang Shandong, 261053, P.R.China.
Institute of Orthopaedics, the 89th Hospital of Chinese PLA.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Nov 8;30(11):1400-1403. doi: 10.7507/1002-1892.20160288.
To investigate the surgical methods and effectiveness to use the iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect.
Between January 2013 and January 2016, iliac flap combined with anterolateral thigh flap was used to repair the first metatarsal bone and large skin defect in 9 patients. There were 5 males and 4 females, with a median age of 15 years (range, 10 to 60 years). The causes included traffic accident injury in 6 cases and crush injury of machine in 3 cases. The average time from injury to operation was 3 hours to 14 days (mean, 7 days). The size of skin soft tissue defect ranged from 10 cm×6 cm to 20 cm×10 cm. The size of first metatarsal bone defect ranged from 2 cm×1 cm to 5 cm×1 cm. The size of iliac flap was 3.0 cm×1.5 cm to 6.0 cm×1.5 cm, and the size of anterolateral thigh flap was 10 cm×6 cm to 20 cm×10 cm. The donor site was directly sutured or repaired by free skin graft.
After operation, the composite flaps survived with primary healing of wound; the skin grafts at donor site survived and the incision healed by first intention. All patients were followed up 6 months to 2 years (mean, 1.6 years). X-ray examination showed that the bone healing time was 3.5-5.0 months (mean, 4 months). The flap had soft texture, good color and appearance. All patients could normally walk. According to the American Orthopaedic Foot and Ankle Society (AOFAS) standard, the foot function was excellent in 6 cases and good in 3 cases, and the excellent and good rate was 100% at last follow-up.
The iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect is a practical way with good shape at one stage.
探讨采用髂骨瓣联合股前外侧皮瓣修复第一跖骨及大面积皮肤缺损的手术方法及疗效。
2013年1月至2016年1月，采用髂骨瓣联合股前外侧皮瓣修复9例第一跖骨及大面积皮肤缺损患者。其中男性5例，女性4例，年龄中位数为15岁（范围10至60岁）。致伤原因包括交通事故伤6例，机器挤压伤3例。受伤至手术的平均时间为3小时至14天（平均7天）。皮肤软组织缺损大小为10 cm×6 cm至20 cm×10 cm。第一跖骨缺损大小为2 cm×1 cm至5 cm×1 cm。髂骨瓣大小为3.0 cm×1.5 cm至6.0 cm×1.5 cm，股前外侧皮瓣大小为10 cm×6 cm至20 cm×10 cm。供区直接缝合或采用游离皮片修复。
术后复合皮瓣全部成活，伤口一期愈合；供区植皮成活，切口甲级愈合。所有患者随访6个月至2年（平均1.6年）。X线检查显示骨愈合时间为3.5至5.0个月（平均4个月）。皮瓣质地柔软，色泽及外观良好。所有患者均能正常行走。根据美国足踝外科协会（AOFAS）标准，末次随访时足部功能优6例，良3例，优良率为100%。
髂骨瓣联合股前外侧皮瓣修复第一跖骨及大面积皮肤缺损是一种一期成形效果良好的实用方法。
