Mooney J F, DeFranzo A, Marks M W
Department of Orthopaedic Surgery, Bowman Gray School of Medicine, Medical Center, Winston-Salem, NC 27157-1070, USA.
J Pediatr Orthop. 1998 Jan-Feb;18(1):26-30.
Pedicled cross-extremity flaps for wound coverage have been replaced, in most cases, by free tissue transfer. Classically, cross-leg flaps have been problematic because of difficulties with immobilization and positioning of the extremities from the time of initial coverage to detachment. Three children with severe foot and ankle trauma had cross-extremity flaps using linkage of bilateral lower-extremity external fixators in place of traditional casting. Cross-leg flaps were used in two patients, and a cross-foot flap was applied in one. Each flap survived completely, and the linking fixators were disassembled at the time of flap detachment. No complications were related to the donor site or the flap itself or were caused by the fixation. Lower-extremity range of motion was regained rapidly, and each patient resumed essentially normal gait and activity. Addition of external-fixator stabilization aids greatly in wound care, as well as general ease of patient mobility and positioning. External fixation facilitates the use of cross-extremity flaps in pediatric patients in whom free tissue transfer may not be optimal.
用于创面覆盖的带蒂交叉肢体皮瓣在大多数情况下已被游离组织移植所取代。传统上，交叉腿皮瓣一直存在问题，因为从最初覆盖到断蒂期间，肢体的固定和摆放存在困难。三名患有严重足踝创伤的儿童采用双侧下肢外固定器连接的方式进行交叉肢体皮瓣移植，取代了传统的石膏固定。两名患者采用了交叉腿皮瓣，一名患者采用了交叉足皮瓣。每个皮瓣均完全存活，断蒂时拆除连接固定器。未发生与供区、皮瓣本身相关的并发症，也没有因固定导致的并发症。下肢活动范围迅速恢复，每名患者基本恢复了正常步态和活动能力。增加外固定器稳定装置对伤口护理、患者的活动便利性和体位摆放都有很大帮助。外固定便于在游离组织移植可能并非最佳选择的儿科患者中使用交叉肢体皮瓣。
