Tsai Po-Lun, Ziegler Otto R, Sudario-Lumague Rowena, Lin Tsan-Shiun
From the Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City; and Chang Gung University College of Medicine, Taoyuan City, Taiwan.
Ann Plast Surg. 2021 Feb 1;86(2S Suppl 1):S91-S95. doi: 10.1097/SAP.0000000000002625.
We aimed to compare different methods to treat lower leg soft tissue defects with tibia fracture using free flaps and pedicled flaps. We also highlighted the aesthetic outcome after using 1-stage secondary debulking procedure for tibia area.
From December 2000 to March 2017, 83 patients with lower leg defects and tibia fractures were reconstructed using 71 free flaps and 12 pedicled flaps. One-stage secondary debulking procedures were performed for 39 patients after flap reconstruction. Infection control and aesthetic outcomes using 5-point Likert scale were reviewed after a 16-month follow-up.
Twenty-five myocutaneous free flaps, 45 fasciocutaneous free flaps, 1 fibula free flap, 12 pedicled flaps of which 8 were distally based sural artery flaps, and 4 medial gastrocnemius flaps were used. The flap survival rate was 100%. There was no recurrence of osteomyelitis in any patient after reconstruction with any of these flaps. Using a 5-point Likert scale, performance of a 1-stage secondary debulking procedure showed statistically significant difference in terms of contour, color, and texture compared with the group without debulking procedure.
The use of free flaps and pedicled flaps in the reconstruction of lower leg defects with tibia fracture is reliable and results in good infection control. A 1-stage secondary debulking procedure delivers excellent long-term aesthetic outcome after reconstruction of the tibia area.
我们旨在比较使用游离皮瓣和带蒂皮瓣治疗伴有胫骨骨折的小腿软组织缺损的不同方法。我们还强调了对胫骨区域采用一期二次减容手术后的美学效果。
2000年12月至2017年3月，83例伴有小腿缺损和胫骨骨折的患者接受了重建手术，其中使用了71个游离皮瓣和12个带蒂皮瓣。39例患者在皮瓣重建后接受了一期二次减容手术。在16个月的随访后，对感染控制情况和采用5分制李克特量表评估的美学效果进行了评估。
使用了25个肌皮游离皮瓣、45个筋膜皮游离皮瓣、1个腓骨游离皮瓣、12个带蒂皮瓣（其中8个为远端蒂腓肠神经营营皮瓣）和4个内侧腓肠肌皮瓣。皮瓣成活率为100%。使用这些皮瓣中的任何一种进行重建后，所有患者均未发生骨髓炎复发。采用5分制李克特量表评估，与未进行减容手术的组相比，一期二次减容手术在外形、颜色和质地方面显示出统计学上的显著差异。
在伴有胫骨骨折的小腿缺损重建中使用游离皮瓣和带蒂皮瓣是可靠的，并且能有效控制感染。一期二次减容手术在胫骨区域重建后可带来优异的长期美学效果。
