Reconstruction of soft tissue defect in non-weight-bearing area of the foot with trimmed free anterolateral thigh muscle flap combined with skin grafting

中华显微外科杂志 Pub Date : 2018-10-25 DOI:10.3760/CMA.J.ISSN.1001-2036.2018.05.005

Rui Hu, Yijun Ren, Li Yan, Xi Chen, Keke Cheng, Shanqing Li, S. Liao

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Abstract

Objective To investigate the clinical effect of reconstruction of soft tissue defect in non-weight-bearing area of the foot with trimmed free anterolateral thigh muscle flap combined with skin grafting. Methods From January, 2009 to January, 2017, 25 patients with soft tissue defect in foot and ankle were treated with transplantation of the trimmed free anterolateral thigh muscle flap combined with skin grafting. Of the 25 cases, there were 5 cases located in medial foot, 10 cases in dorsum of foot, 7 cases in external of foot and 3 cases in the toe. The areas of wounds were 8.0 cm×6.0 cm to 18.0 cm×10.0 cm. The anterolateral thigh muscle flap was from 4.0 cm×3.0 cm×0.3 cm to 10.0 cm×8.0 cm×1.5 cm. All the cases were operated in fracture fixation and wound without obvious infection. Early rehabilitative exercise under the protection of orthosis were done after 4 weeks of the operation and to assess. The injuried limb function were assessed in 1 year postoperatively according to Marylands scale. Results All cases were followed-up for 12 to 24 months (average, 16.2 months) . All the muscle flaps and skin survived. The healing time were 12 to 24 days, averaged of 17.1 days. Patients could wear shoes normally and resume normal life and work. The appearance and walking function were satisfying and no further debulking procedures were needed. The surgery function were assessed according to Marylands scale, and the results was 22 cases for excellent, and 3 cases for good. Conclusion Ttrimmed free anterolateral thigh muscle flap combined with skin grafting is a good option for the repair of foot and ankle defect at non-weight-bearing area, and it has the advantages such as the doner site is small invasive, the muscle flap is easy to be harvested, and can avoid debulking surgery to wear shoes normally. Key words: Anterolateral thigh muscle flap; Foot; Transplantation; Soft tissue defect; Microsurgical technique

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切除游离大腿前外侧肌瓣联合植皮修复足部非承重区软组织缺损

目的探讨带蒂股前外侧游离肌瓣联合植皮修复足部非负重区软组织缺损的临床效果。方法自2009年1月至2017年1月，对25例足踝软组织缺损患者采用修剪后的股前外侧游离肌瓣移植联合植皮治疗。25例中，5例位于足内侧，10例位于足背，7例位于足外侧，3例位于足趾。创面面积8.0cm×6.0cm～18.0cm×10.0cm，股前外侧肌瓣4.0cm×3.0cm×0.3cm～10.0cm×8.0cm×1.5cm，均采用骨折固定术，创面无明显感染。术后4周在矫形器的保护下进行早期康复训练并进行评估。根据Marylands量表对术后1年的肢体损伤功能进行评估。结果所有病例随访12～24个月，平均16.2个月。所有的肌肉瓣和皮肤都存活了下来。愈合时间12～24天，平均17.1天。患者可以正常穿鞋，恢复正常的生活和工作。外观和行走功能都令人满意，无需进一步的拆封程序。根据Marylands量表对手术功能进行评估，结果为优22例，良3例。结论T型股前外侧游离肌瓣联合皮片移植是修复非负重区足踝关节缺损的一种较好的选择，具有手术部位创伤小、肌瓣易于获取、可避免拆台手术而正常穿鞋等优点。关键词：大腿前外侧肌皮瓣；足部；移植；软组织缺损；显微外科技术

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来源期刊

中华显微外科杂志

CiteScore

0.50

自引率

0.00%

发文量

6448

期刊介绍： Chinese Journal of Microsurgery was established in 1978, the predecessor of which is Microsurgery. Chinese Journal of Microsurgery is now indexed by WPRIM, CNKI, Wanfang Data, CSCD, etc. The impact factor of the journal is 1.731 in 2017, ranking the third among all journal of comprehensive surgery. The journal covers clinical and basic studies in field of microsurgery. Articles with clinical interest and implications will be given preference.