游离皮瓣Taylor支架治疗踝周骨与软组织缺损
Free flap and bone transportation with Taylor spatial frame for bone and soft tissue defects around ankle
罗桦杰 1王朝辉 1余卓安 2詹晓欢 1李卓伟 1杨松1
作者信息
- 1. 佛山市中医院修复重建外科,广东佛山 528000
- 2. 广州中医药大学,广东广州 510006
- 折叠
摘要
[目的]介绍游离皮瓣联合Taylor支架(taylor spatial frame,TSF)治疗踝周骨与软组织缺损的手术技术和初步临床结果.[方法]2016年1月—2020年2月共治疗踝周骨与软组织缺损16例患者,一期行彻底清创,清除感染坏死骨与软组织,使用外固定支架临时固定,缺损创面使用负压海绵覆盖.二期根据创面部位、面积和软组织缺损情况及血管条件分别选用游离背阔肌皮瓣、股前外侧肌皮瓣、腓肠肌内侧肌皮瓣对踝周皮肤缺损进行修复.皮瓣成活后三期根据骨缺损范围预设TSF骨延长及胫距融合构型,术中根据治疗要求,安装固定TSF并完成截骨.术后1周根据术前测量的畸形、安装、框架参数制定电子处方,以1 mm/d,分4次调整的速度,开始骨延长及调整TSF,最终完成牵张成骨和胫距融合.[结果]16例患者均获随访,随访时间14～52个月.术后外固定架总佩戴时间平均(17.3±2.4)个月,愈合时间平均(14.8±1.4)个月,总治疗时间平均(17.9±2.2)个月.末次随访时,胫骨总延长平均(7.5±1.1)cm.按AOFAS踝及后足评分进行评定:优12例,良4例.[结论]游离皮瓣结合TSF治疗踝周骨与软组织缺损,可有效修复缺损组织,胫距关节融合成功率高,负重力线恢复好,成功重建下肢功能.
Abstract
[Objective]To introduce the surgical technique and preliminary clinical results of free flap and bone transportation with Taylor spatial frame(TSF)for bone and soft tissue defects around the ankle.[Methods]A total of 16 patients were surgically treated for bone and soft tissue defects around the ankle from January 2016 to February 2020.In the first stage,complete debridement was performed to remove infected and necrotic bone and soft tissue,temporary fixation was performed with a simple external fixation frame,and the defect wound was covered with vacuum sealing drainage(VSD).In the second stage,according to the wound site,area,soft tissue defect and vascu-lar condition,the free lat dorsal myocutaneous flap,anterolateral femoral myocutaneous flap and medial gastrocnemius myocutaneous flap were used to repair the soft tissue defect.After the survival of the flap,the bone transportation or tibiotalars fusion with TSF were performed at the third stage according to the extent of bone defects.During the last operation,TSF was installed and fixed according to the require-ments of treatment with osteotomy.One week after the surgery,an electronic prescription was made according to the deformity,installation and frame parameters measured before surgery.The bone transportation with TSF were adjusted at a rate of 1 mm/d per day,divided into four times,and finally distraction osteogenesis and tibial talus fusion were completed.[Results]All the 16 patients were followed up for 14～52 months,with external frame wearing time of(17.3±2.4)months,the bone healing of(14.8±1.4)months,and the total treatment time of(17.9±2.2)months.At the last follow-up,total tibial lengthening was of(7.5±1.1)cm.The clinical outcome was marked as excellent in 12 cases and good in 4 cases based on AOFAS criteria.[Conclusion]Free flap and bone transportation with Taylor spatial frame can effective-ly repair bone and soft tissue defects around the ankle,with high success rate of tibiotalar fusion,good recovery of alignment and successful reconstruction of lower limb function.
关键词
Taylor空间支架/骨搬移/游离皮瓣/踝关节/胫距融合术Key words
Taylor spatial frame/bone transportation/free flap/ankle/tibiotalar fusion引用本文复制引用
基金项目
广东省重点领域研发计划项目(2020B1111150001)
广东省基础与应用基础研究基金项目(2022A1515220061)
佛山市重点领域科技攻关项目(2020001006106)
出版年
2024
NETL
NSTL
万方数据