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CLINICAL APPLICATION OF THE UL-TRA LENGTH AND WIDTH RANDOM CALF FASCIOCUTANEOUS FLAP

The ultra length and width random calf fasciocutaneous flaps whose blood supply came from the calf fasciocutaneous vascular network were transposed in 9 cases for the treatment of severe trauma of leg. All of the flaps survived except one having necrosis of the distal fourth. The length and width of the flap to the width of the pedicle were 6.1∶1 and 2.7∶1 respectively. Properly extended the area and decreased of blood perfusion of the flan would reduce the burden of the venous backflow to the flap relatively. The abundant vascular networks of the calf fasciocutaneous flap was a very important factor that this type of flap would possibly survive.

踝周组织缺损修复

RECONSTRUCTION OF LEG AND ANKLE DEFECTS BY USING FREE RECTUS ABDOMINIS MUSCLE FLAPS WITH INTERMEDIATE SPLIT THICKNESS SKIN GRAFT

Objective To study the method and effect of free rectusabdominis muscle flaps with intermediate split thickness skin graft in repairing defects on legs and ankles.Methods From May 1998 to December 2002, 11 cases of defects on legs(2 cases) and on ankles( 9 cases) were repaired by use of unilateral free rectus abdominis flap with skin graft. The soft tissue defects were accompanied by osteomyelitis or the exposure of bone or tendon.The disease course was 1 month to 10 years. The defect size ranged 3 cm×4 cm to 8 cm×14 cm. The area ofrectus abdominis muscle flaps was 4 cm×6 cm to 8 cm×15 cm. Results All patients were followed up 6 months to 4 years after operation. All rectusabdominis flaps survived with good appearances and functions.The primary healing was achieved in 8 cases, intermediate split thickness skin graft necrosed in 3 cases and the wound healed after skin re-graft.Conclusion Free rectus abdominis flap is a proper option for repair of the soft tissue defects or irregular woundson legs and ankles. It has the advantages of abundant blood supply, b anti-infection ability, good compliance and satisfied appearance.

小腿内侧神经血管蒂皮瓣修复足部软组织缺损

高频彩色多普勒超声诊断肌疝一例

小腿远端蒂复合血管网皮瓣修复足踝部皮肤缺损

目的 探讨小腿远端蒂复合血管网皮瓣的血供特点及临床疗效。 方法 2004年2月～2005年12月，应用包含深筋膜、皮神经及浅静脉的小腿远端蒂复合血管网皮瓣修复足踝部皮肤缺损伴肌腱或骨外露创面16例，其中急诊修复6例，择期修复10例。男11例，女5例；年龄16～48岁。皮瓣切取范围9 cm×5 cm～17 cm×14 cm。 结果 术后16例皮瓣均成活，切口Ⅰ期愈合。患者均获随访1～8个月。皮瓣血循环良好，耐磨无破溃，有浅痛觉及触觉，两点辨别觉40～96 mm，受区臃肿不明显。供区创面Ⅰ期愈合。 结论 小腿远端蒂复合血管网皮瓣操作安全，成活率高，是修复足踝部皮肤缺损的一种有效方法。

The Repair of Lower Leg, Ankle and Foot Soft Tissue Defects

目的　评价不同皮瓣、肌皮瓣修复小腿及足踝部皮肤软组织缺损的效果，探讨小腿及足踝部皮肤软组织缺损的理想修复方法。 方法　2002年6月－2010年1月，应用15种皮瓣、肌皮瓣修复128例（138处）小腿及足踝部皮肤软组织缺损。其中小腿中上段21处，小腿中下段45处，内外踝及足跟部43处，足背及前足29处。主要应用最多的皮瓣有腓肠神经营养血管皮瓣、腓肠肌内外侧头肌皮瓣、腓浅神经营养血管皮瓣和足底内侧皮瓣。修复软组织缺损范围5 cm×4 cm～23 cm×14 cm。 结果　术后135处创面Ⅰ期愈合，皮瓣完全成活；2处皮瓣部分坏死，经二次手术植皮修复；1例游离股前外侧皮瓣修复小腿中下段软组织缺损，皮瓣完全坏死，后改取对侧腓肠神经营养血管交腿皮瓣修复成活。腓肠神经营养血管皮瓣应用例数最多，成活率高，吻合血管的游离皮瓣坏死率较高。术后患者均获随访1～10年，平均23个月，皮瓣均成活良好, 无溃疡、渗液等。 结论　正确认识并选择皮瓣、肌皮瓣修复小腿及足踝部皮肤软组织缺损可提高皮瓣成活率，恢复肢体良好功能，腓肠神经营养血管皮瓣是一种修复小腿及足踝部软组织缺损的理想皮瓣。

错位环扎法治疗下肢深静脉栓塞后小腿溃疡21例

TREATMENT OF OSTEOCUTANEOUS DEFECT OF LEG BY REVERSED OR PERI0STEOCUTANEOUS FLAP OF TIBIA

This article introduced a newmethod of repaire of osteocutaneousdefect of the lower leg by thetransfer of periosteocutaneous flap.The donor artery was the posteriortibial artery which supplied the skinof the medial aspect of the middleand lower leg. The medial skin flapof the leg had vascular communicat-ion with the periostium of the ant-erior aspect of the tibia. The shapeand size of the flap could be design-ed according to the recipient area,and the flap axis should be along theline from medial tibial condyle to the medial malleolus, generelly at the level of 3.7.11. or 15cm above the medial malleolus. The skin defect could be repaired by free graft, and 2 patients received this operation had achieved good result after 1 year follow-up.

小腿踝上穿支蒂螺旋桨皮瓣修复足底黑色素瘤切除后创面

目的总结小腿踝上穿支蒂螺旋桨皮瓣修复足底黑色素瘤切除后创面的疗效。方法2016 年 4 月—2018 年 6 月，收治 6 例足底黑色素瘤患者。男 2 例，女 4 例；年龄 32～53 岁，平均 36 岁。病程 1～320 个月，中位病程 58 个月。肿瘤扩大切除后，遗留创面范围为 5.8 cm×4.5 cm～10.6 cm×8.7 cm，切取小腿踝上穿支蒂螺旋桨皮瓣修复。皮瓣旋转后大桨无张力修复创面，小桨修复供区创面；皮瓣切取范围为 8.5 cm×6.8 cm～12.0 cm×10.5 cm。供区经皮瓣修复后 4 例直接拉拢缝合、2 例游离植皮修复。结果术后除 1 例皮瓣部分表皮坏死，其余皮瓣及植皮均顺利成活，创面及供区切口均Ⅰ期愈合。患者均获随访，随访时间 3～24 个月，平均 18 个月。除 3 例皮瓣臃肿行二期修整外，其余皮瓣外形良好，色泽、质地及弹性佳；足底浅感觉不同程度恢复。末次随访时，按美国矫形足踝协会（AOFAS）评分，获优 4 例、良 1 例、可 1 例，优良率为 83.3%。随访期间无肿瘤复发。结论小腿穿支蒂螺旋桨皮瓣质地与足底组织相似，皮瓣易于旋转，无需牺牲主要血管，适用于修复足底黑色素瘤切除后创面。