Zukowski M, Lord J, Ash K, Shouse B, Getz S, Robb G
Department of Plastic & Reconstructive Surgery, Naval Medical Center Portsmouth, VA, USA.
Ann Plast Surg. 1998 Feb;40(2):141-4. doi: 10.1097/00000637-199802000-00006.
Trauma to the extremities often results in a complex bony and soft-tissue injury requiring free flap reconstruction. Muscles from various body sites have been used in extremity reconstruction since the early 1970s. The gracilis muscle is usually not considered the first choice for free flap reconstruction of these defects. It is usually relegated to small defects or used to reanimate the face. Our purpose is to present our experience with the gracilis muscle as a first-choice flap in reconstruction of traumatic extremity defects. A retrospective review of all gracilis muscle free flap transfers for traumatic extremity wounds between 1988 and 1995 at the Naval Medical Center Portsmouth was performed. Twenty-five patients age 20 to 71 years (mean, 29.7 years) underwent 26 free flaps to the lower leg, ankle, foot, or forearm to cover traumatic wounds. Defects ranged in size from 3 x 3 cm (9 cm2) to 13 x 18 cm (234 cm2), with a mean of 75.5 cm2. There were no flap losses and all wounds healed. Nine patients experienced 11 complications, which consisted of minor wound separation (16%), wound infection (12%), partial or complete loss of split-thickness skin graft (8%), thrombosis of graft with successful revascularization (4%), and nonunion of an underlying fracture (4%). Our overall success rate for gracilis free flap reconstruction of traumatic wounds is 100%. The gracilis free muscle flap has become our first option for tissue coverage in traumatized extremities. It leaves minimal functional defect limited to the side of the primary injury and provides a good cosmetic result. It can cover large defects when the epimysium is cut, and allows an epidural block to be performed for sympathectomy effect and pain control in the affected extremity during the immediate postoperative period.
四肢创伤常导致复杂的骨与软组织损伤，需要游离皮瓣重建。自20世纪70年代初以来，来自身体不同部位的肌肉已被用于四肢重建。股薄肌通常不被认为是这些缺损游离皮瓣重建的首选。它通常用于小缺损或用于面部功能重建。我们的目的是介绍我们将股薄肌作为重建创伤性四肢缺损的首选皮瓣的经验。对1988年至1995年在朴茨茅斯海军医疗中心进行的所有用于创伤性四肢伤口的股薄肌游离皮瓣移植进行了回顾性研究。25例年龄在20至71岁（平均29.7岁）的患者接受了26次游离皮瓣移植至小腿、踝部、足部或前臂以覆盖创伤性伤口。缺损大小从3×3厘米（9平方厘米）至13×18厘米（234平方厘米）不等，平均为75.5平方厘米。没有皮瓣丢失，所有伤口均愈合。9例患者出现11种并发症，包括轻微伤口裂开（16%）､伤口感染（12%）､中厚皮片部分或完全丢失（8%）､移植皮瓣血栓形成但再血管化成功（4%）以及潜在骨折不愈合（4%）。我们采用股薄肌游离皮瓣重建创伤性伤口的总体成功率为100%。股薄肌游离肌皮瓣已成为我们用于创伤四肢组织覆盖的首选。它仅在原发损伤侧留下最小的功能缺陷，并提供良好的美容效果。当肌外膜被切开时，它可以覆盖大的缺损，并允许在术后即刻进行硬膜外阻滞以产生交感神经切除效应并控制患侧肢体的疼痛。
