Panagatla Prakash, Ravula Parvathi, Chandrashekar Patnala, Srikanth R, Alekya Nakka
Department of Plastic and Reconstructive Surgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India.
Department of Orthopaedic Surgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India.
Indian J Plast Surg. 2023 Feb 7;56(1):31-38. doi: 10.1055/s-0042-1760094. eCollection 2023 Feb.
The axial vessels like the anterior and posterior tibial emerge as the first choice of recipient vessels, in free flaps for lower limb trauma. When the defects are located more proximally in the leg, the deeper course of the axial vessels makes the dissection more tedious. Alternative vessels like the descending genicular, medial genicular, and distal end of the descending branch of the lateral circumflex femoral can be used for an end-to-end anastomosis, well away from the zone of trauma. The objective of this study was to define the indications and technique of the use of the sural vessels as the recipient pedicle for proximal and middle third leg defects. For the period 2006 to 2022, 18 leg defects following road traffic accidents were covered with latissimus dorsi muscle flap using sural vessels as the recipient pedicle. Among 18 patients, 8 patients had defect in proximal third, 8 had a combined defect in proximal and middle third leg, and 2 had defect in middle third leg. Two patients developed arterial thrombosis and one patient had venous thrombosis for which re-exploration was performed. Two flaps were lost and sixteen had successful wound coverage. The sural vessels as recipient pedicle are easier to access and can be considered as a reliable option for free flaps in limb defects of proximal and middle third leg. Using the submuscular part of the vessel ensures a better distal reach of the flap.
在下肢创伤的游离皮瓣手术中，胫前和胫后等轴型血管成为首选的受区血管。当缺损位于小腿更近端时，轴型血管走行较深，会使解剖操作更加繁琐。像膝降血管、膝内侧血管以及旋股外侧动脉降支远端等替代血管可用于端端吻合，且远离创伤区域。本研究的目的是明确将腓肠血管作为小腿近、中1/3段缺损受区蒂的适应证和技术。
在2006年至2022年期间，18例道路交通事故后小腿缺损患者采用以腓肠血管为受区蒂的背阔肌肌皮瓣进行覆盖。
18例患者中，8例为小腿近1/3段缺损，8例为小腿近、中1/3段联合缺损，2例为小腿中1/3段缺损。2例发生动脉血栓形成，1例发生静脉血栓形成，均进行了再次探查。2例皮瓣坏死，16例皮瓣成功覆盖创面。
以腓肠血管作为受区蒂更容易显露，可被视为小腿近、中1/3段肢体缺损游离皮瓣的可靠选择。利用血管的肌下部分可确保皮瓣有更好的远端覆盖范围。
