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劈开外侧腓肠肌肌皮瓣再创新用于复杂胫骨近端开放性骨折:病例报告

Re-innovation of split lateral gastrocnemius muscle flap for complicated proximal tibia open fracture: Case report.

作者信息

Yassin Amin M, Mohamed Momen, Mohammed Maany, Dirar Mohamed, Ahmed Muhnnad, Salah Musab

机构信息

Department of plastic surgery, Alsrorab hospital, Khartoum, Sudan.

Department of plastic surgery, Alsrorab hospital, Khartoum, Sudan.

出版信息

Int J Surg Case Rep. 2024 Sep;122:110159. doi: 10.1016/j.ijscr.2024.110159. Epub 2024 Aug 13.

Abstract

INTRODUCTION AND IMPORTANCE

Maintaining mobility and hence the productivity of individuals depends on the preservation of lower limb integrity. Increasing violence, mainly triggered by weapons, inversely impacts limb functionality, and the resulting wounds require proper care.

CASE PRESENTATION

A 47-year-old African man without any previous medical conditions experienced an injury to his right leg from a high-speed accident, resulting in an open fracture in the upper third of the tibia with missing tissue. At first, he received care from orthopedic surgeons and had debridement done along with the use of an external fixation device to stabilize his limb. Two weeks later, he was referred to the plastic surgery unit and was preparing for urgent surgery. A split lateral gastrocnemius muscle flap was used to reconstruct him after a surgical debridement.

CLINICAL DISCUSSION

Proximal leg trauma can be managed successfully by rearrangement of local tissue, resulting in a perfect outcome with less donor site morbidity and a long, complex surgery compared to free tissue transfer. Gastrocnemius muscle or myocutaneous flap, is a gold standard for proximal leg trauma, mainly when a cavity exists, and it is able to create satisfactory reconstruction.

CONCLUSION

The split lateral gastrocnemius muscle flap is an effective modification of the flap, resulting in greater surface area coverage, less bulk and shape distortion, and reliable blood supply. Furthermore, it is easy to harvest and apply, deferring the need for step-curve microsurgical procedures.

摘要

引言与重要性

维持个体的活动能力以及由此带来的生产力取决于下肢的完整性。暴力事件不断增加,主要由武器引发,这对肢体功能产生负面影响,而由此造成的伤口需要妥善处理。

病例介绍

一名47岁的非洲男性,既往无任何病史,因高速事故导致右腿受伤,造成胫骨上三分之一处开放性骨折且伴有组织缺损。起初,他接受了骨科医生的治疗,进行了清创术并使用外固定装置来稳定肢体。两周后,他被转诊至整形手术科室并准备进行紧急手术。在手术清创后,采用了外侧腓肠肌劈开肌瓣对其进行重建。

临床讨论

通过局部组织重新排列可成功处理小腿近端创伤,与游离组织移植相比,其手术结果完美,供区并发症少,手术虽长但不复杂。腓肠肌肌瓣或肌皮瓣是小腿近端创伤的金标准,主要适用于存在腔隙的情况,且能够实现令人满意的重建。

结论

外侧腓肠肌劈开肌瓣是该肌瓣的一种有效改良,可实现更大的表面积覆盖、更少的体积和形状变形,以及可靠的血供。此外,它易于切取和应用,无需进行分步曲线显微外科手术。

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