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目的 总结与探讨应用吻合血管皮瓣、肌皮瓣修复小腿创伤后严重复杂软组织缺损的疗效与经验. 方法 自2009年10月至2011年12月,对小腿严重创伤后复杂软组织缺损59例患者,在全身情况稳定、局部急性感染已基本控制的情况下,反复彻底扩创,创面用VSD覆盖保护.待创面肉芽新鲜、清洁后应用单一皮瓣、肌皮瓣吻合血管移植修复56例,单一组织瓣不能满足缺损修复需要者3例,选用2块组织瓣组合移植,对受区无合适可供血管吻合者5例,采用桥式交叉血管吻合移植.单块组织瓣面积最大32 cm×13 cm,最小15 cm×8 cm,组合组织瓣皆为2块. 结果 59例组织瓣移植均获成功,受区伤口Ⅰ期愈合57例,Ⅱ期愈合2例,1例供区继发伤口感染,经换药扩创后再次植皮治愈.肢体严重复杂软组织缺损得以修复重建,毁损肢体得以挽救,功能得以保留. 结论 应用显微外科技术采用吻合血管皮瓣、肌皮瓣修复创伤后小腿严重复杂难治性软组织缺损是缩短疗程、挽救肢体、保护与恢复功能最有效的、不可替代的方法.

Objective To summary and discuss the curative effect and experience of repairing serious and complicated soft tissue defects of traumatic shank by flap or musculocutaneous flap by anatomosis.Methods From October 2009 to December 2011, the wounds of 59 patients suffering from serious and complicated soft tissue defects of traumatic shank were covered by VSD after repeated debridement,when the conditions of the whole bodies were stable and the local acute infection was controlled in the main. Fifty-six patients were repaired by a single flap or musculocutaneous flap attributing to the fresh granulation, three patients were repaired by compound tissue flaps because a single flap was insufficient. Five patients who had no available blood vessels at recipient site were repaired by flaps with bridge cross vascular anatomosis. The compound flaps were no more than 2 pieces, the maximum area of flap was 32 cm × 13 cm, the minimum was 15 cm × 8 cm. Results The flaps of all of 59 cases survived, fifty-seven cases were healed in one stage, two in two stage, one case had complication of infection at donate site due to the hematocele, and was cured by debridement and skin graft. Serious and complicated soft tissue defects of shanks were repaired by reconstruction,damaged limbs were salvaged,the functions of the legs were reserved. Conclusion It is the most effective and irreplaceable way that using flaps and musculocutaneous flaps,by anatomosis with the microsurgery technique, repairs the serious and complicated soft tissue defects of shank, which can shorten course and salvage the damaged limbs.