Plastic Surgery and Burns Unit, Centre François-Xavier Michelet, Bordeaux University Hospital, 33076 Bordeaux, France; Department of Orthopaedic Surgery 1 and 2, Trousseau University Hospital, Medical University François-Rabelais, Tours, France.
Plastic Surgery and Burns Unit, Centre François-Xavier Michelet, Bordeaux University Hospital, 33076 Bordeaux, France.
Ann Chir Plast Esthet. 2021 Jun;66(3):234-241. doi: 10.1016/j.anplas.2020.07.010. Epub 2020 Aug 13.
The purpose of this study was to evaluate the results of the medial adipofascial flap (MAF) in infected tibia fractures reconstruction and to identify criteria for success or failure.
Fifty-nine patients treated with a MAF were enrolled. Age, BMI, tobacco use and bone status were recorded. Early and late postoperative complications were assessed. Bone healing and flap success were systematically evaluated at 12 months.
Tibia fractures were initially open in 48 cases (81%) and closed in 11 cases (19%). Infection was acute (<30 days) in 9 cases (15%) and chronic in 50 (85%). Thirty-one patients (53%) experienced no early postoperative complications (<30 days). There were 10 (17%) cases of necrosis of the skin graft, 2 (3%) cases of necrosis and 4 (7%) haematomas in the harvesting area, 7 (12%) cases of partial flap necrosis at its tip and 4 (7%) flap failures. None of the criteria was statistically correlated with the occurrence of a complication. At 12 months, 53 flaps (90%) were successful. Immediate skin graft were significantly correlated with flap success (P=0.05). Forty-six patients (78%) had complete bone healing documented by CT scan.
The MAF provides a reliable alternative for lower leg reconstruction. Its major advantages are sparing of the major leg vessels, no donor site morbidity and relatively easy and rapid dissection.
本研究旨在评估内侧脂肪筋膜瓣（MAF）在感染性胫骨骨折重建中的效果，并确定成功或失败的标准。
共纳入 59 例接受 MAF 治疗的患者。记录了年龄、BMI、吸烟情况和骨骼状况。评估了早期和晚期术后并发症。在 12 个月时系统评估了骨愈合和皮瓣成功情况。
48 例（81%）胫骨骨折最初为开放性，11 例（19%）为闭合性。9 例（15%）为急性感染（<30 天），50 例（85%）为慢性感染。31 例患者（53%）无早期术后并发症（<30 天）。有 10 例（17%）皮肤移植坏死，4 例（7%）皮瓣尖端部分坏死，4 例（7%）供区血肿，2 例（3%）皮瓣坏死。没有任何一项标准与并发症的发生有统计学相关性。在 12 个月时，53 个皮瓣（90%）成功。立即进行皮肤移植与皮瓣成功显著相关（P=0.05）。46 例患者（78%）通过 CT 扫描证实完全骨愈合。
MAF 为小腿重建提供了可靠的替代方法。其主要优点是保留了主要腿部血管、无供区并发症且相对容易和快速进行解剖。
