旋髂深血管蒂髂骨皮瓣移植再造跖骨并重建足弓

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1、旋髂深血管蒂髂骨皮瓣移植再造跖骨并重建足弓姚忠军等.旋髂深血管蒂髂骨皮瓣移植再造跖骨并重建足弓?l45? [文章编号]1006—9674(2004)03—0l45一O4 旋髂深血管蒂髂骨皮瓣移植 再造跖骨并重建足弓 姚忠军.,何明武 (郧阳医学院附属太和医院创伤骨科,湖北十堰442000) [摘要]目的:探讨旋髂深血管蒂髂骨皮瓣移植再造跖骨并重建足弓的手术要点及临床疗效,为前足创伤性复合 组织缺损的修复提供一种新术式.方法:自1998年5月～2003年1O月,应用吻合旋髂深血管的髂骨皮瓣移植,I 期修复跖骨缺损伴前足软组织缺损并重建足弓7例,随访3～24个月,平均18个月.结果:7例均成活,其

2、中1例髂 骨皮瓣边缘少许坏死经换药处理后愈合;复查x线片示:术后3～4个月达骨性愈合,再造跖骨成活良好,无骨坏死 吸收及骨不连发生,重建足弓形态满意,可恢复负重行走功能.结论:旋髂深血管解剖恒定,管径粗大,血管蒂长.髂 骨皮瓣血供丰富,移植手术操作简便,可同时修复多个跖骨缺损,髂骨瓣的骨质及弧度,厚度与跖骨相似,重建足弓 符合足弓的生物力学特性,是修复前足创伤性复合组织缺损的好方法. [关键词]髂骨皮瓣;重建;跖骨;足弓;旋髂深血管 [中图法分类号]R658[文献标识码]A ReconstructionofMetatarsusandArchofFootUsingIliacOsteocutahe

3、ousFreeFlapsBasedontheDeepCircumflexIliac VesselsYAOZhong—jun.HEMing—WU(TheDepartmenlofOsteopidics,r』ihehospital,Yu一. nyangMedicalcol lege.Shiyan.Hubei442000) Abstract:ObjectiveTodiscusstheessential0foperationandcliniceffectofthetransplantation0ftheiliacosteocutane— OUScompositeflapsbasedOilthedeepc

4、ircumflexiliac,resselsforreconstructingthemetatarsusandthearchoffoot. TodesignanewmethodforrepairingthecompositetissuesdefectOfforefoot.MethodsFromMayl998tO()ctober 2003.theiliacosteocutaneousfreeflapsvascularizedbythedeepcircumflexiliacvesselswereusedtOreconstructthe metatarsusandthearchoffoot.repa

5、irthesofttissuesdefectofforefootatonestageon7cases.l’hefollow—upperiod rangedfrom3tO24months,withanaverageof18months.ResultAlltheflapssurvived.thoughoileflaphadsome necrosisontheedgeportion,whichhealedbychangingdressing.After3tO4monthspostoperation.X—rayshowthat thebonejointedtogetherandthecomposite

6、flapsurvivedcompletely,Therewasnocomplicationofosteonecrosisor non—union,theshapeofreconstructedarchesofthelootswassatistactory.Thepatientsrecoveredfullweightbearing capabilityafterayear.OonclusionTheanatomyofdeepcircumflexiliacvesselsiseternal,thevasculardiametersizeal— lowsgreaterreliabilityforthe

7、microvascularanastomosis,thepedicelislongenough,theiliacosteocutaneousflaphas adequatebloodsupply,operationissimple,multiplemetatarsusdefectscanbereconstructedatonesetting.theilium closelyapproximates