Robotti E, Verna G, Fraccalvieri M, Bocchiotti M A
Department of Plastic Surgery of the Ospedali Riuniti, Bergamo, Italy.
Plast Reconstr Surg. 1998 Apr;101(4):1014-21. doi: 10.1097/00006534-199804040-00020.
Early reconstructive treatment of war-related lower extremity injuries can be feasible even when evacuation to ideal tertiary facilities is impossible. However, in such instances, lengthy procedures considered "state of the art" in the everyday civilian practice of plastic surgery are often impractical, and alternative options need to be sought. Undelayed distally based fasciocutaneous flaps of the leg have recently been used in 12 cases of extensive defects of the foot due to antipersonnel mine injuries. All patients, treated during the conflict in Bosnia-Herzegovina, were smokers and were between 17 and 45 years of age. No preoperative arteriography or Doppler was available. One flap was totally lost, and two others suffered tip necrosis. All other cases healed uneventfully. We were impressed at the reliability of distally based fasciocutaneous flaps, even with length-to-width ratios of up to 5:1, and even after distal deepithelialization or tubing of the pedicle. The whole foot can be reached when the appropriate lateral or medial based flap is selected. Obvious disadvantages are the grafted secondary defect of the leg and the lack of sensation, although the latter is a common feature shared by most other flaps to the foot. Also, free-muscle transfer is preferable for very deep defects with extensive bone loss. However, for the ease of dissection, versatility, and short operating time, distally based fasciocutaneous flaps find a definite place in reconstructive trauma surgery.
即使无法将伤员后送至理想的三级医疗机构，对与战争相关的下肢损伤进行早期重建治疗仍可能是可行的。然而，在这种情况下，整形外科日常临床实践中被视为“先进技术”的冗长手术往往不切实际，需要寻求其他替代方案。最近，已将基于小腿远端的筋膜皮瓣用于12例因杀伤人员地雷伤导致足部广泛缺损的病例。所有患者均在波斯尼亚和黑塞哥维那冲突期间接受治疗，均为吸烟者，年龄在17至45岁之间。术前未进行动脉造影或多普勒检查。1个皮瓣完全坏死，另外2个皮瓣出现尖端坏死。其他所有病例均顺利愈合。我们对基于远端的筋膜皮瓣的可靠性印象深刻，即使长宽比高达5:1，即使在蒂部远端去上皮化或制成管状之后也是如此。选择合适的基于外侧或内侧的皮瓣时，可以覆盖整个足部。明显的缺点是小腿会出现移植后的继发缺损以及感觉缺失，不过后者是大多数其他用于足部的皮瓣共有的常见特征。此外，对于伴有广泛骨质丢失的非常深的缺损，游离肌肉移植更为可取。然而，基于远端的筋膜皮瓣因其解剖操作简便、适用性广且手术时间短，在创伤重建手术中占有一定地位。
