Tropet Y, Najean D, Brientini J M, Elias B E, Vichard P
Service de Chirurgie Orthopédique, Traumatologique et Plastique, CHU Jean Minjoz, Besançon.
Ann Chir Plast Esthet. 1993 Oct;38(5):584-9; discussion 590.
The authors report 7 cases of extensive skin defects of the foot and/or the ankle treated by using a free flap. All cases presented with major trauma of the lower limb with obvious exposure of bone and joint tissues. The skin defect was covered: as an emergency in 4 cases; within the 48 hours following the trauma in 3 cases; on the 7th day after the injury in 1 case. The free flap used was: the latissimus dorsi muscle, 2 cases; the gracilis muscle, 1 case; the serratus anterior muscle, 1 case; the greater omentum, 2 cases. Arterial microanastomoses were performed onto the anterior tibial or pedal arteries, in 4 cases, and onto the posterior tibial artery in 4 cases. Except for 1 failure on the 8th day after the operation due to thrombosis of the venous anastomosis, requiring arthrodesis of the ankle, the outcome was favorable in all other cases, free of osteitis or arthritis. The authors emphasize the importance of covering defects the lower limb as quickly as possible, ideally as an emergency, when a free flap is required.
作者报告了7例采用游离皮瓣治疗的足部和/或踝部大面积皮肤缺损病例。所有病例均有下肢严重创伤，伴有明显的骨和关节组织外露。皮肤缺损的覆盖情况如下：4例为急诊覆盖；3例在创伤后48小时内覆盖；1例在受伤后第7天覆盖。所采用的游离皮瓣为：背阔肌皮瓣2例；股薄肌皮瓣1例；前锯肌皮瓣1例；大网膜皮瓣2例。4例动脉显微吻合至胫前动脉或足背动脉，4例至胫后动脉。除1例术后第8天因静脉吻合口血栓形成失败，需行踝关节融合术外，其他病例预后良好，无骨髓炎或关节炎。作者强调，当需要游离皮瓣时，尽快覆盖下肢缺损非常重要，理想情况下应作为急诊处理。
