游离股薄肌肌皮瓣联合膝上内侧皮瓣重建屈仲指功能疗效观察

摘要

目的 探讨游离股薄肌肌皮瓣联合膝上内侧皮瓣重建屈伸指功能及修复前臂软组织缺损的临床效果.方法 回顾性分析2012年9月至2016年2月6例以游离股薄肌肌皮瓣联合膝上内侧皮瓣重建屈伸指功能及修复前臂软组织缺损创面的临床资料,观察肌皮瓣及皮瓣成活情况并随访其疗效.结果 6例皮瓣全部成活,其中1例术后2d近端皮瓣出现动脉危象,经探查重新吻合后成活,有l例远端少许表皮坏死,经换药后愈合,其余4例伤口均Ⅰ期愈合.成活后腕部肌腱有粘连再次予以松解,随访＞1年手指均可不同程度屈曲.结论 游离股薄肌肌皮瓣联合膝上内侧皮瓣重建患肢屈伸指功能及修复前臂大面积软组织缺损效果良好.%Objective To investigate the clinical effect of free gracilis muscle flap combined with upper medial knee flap in reconstruction of flexion and extension fingers and repair of soft tissue defect of forearm.Methods A retrospective analysis was conducted on six cases from September 2012 to February 2016 with free gracilis muscle flap and medial supragenicular flap reconstruction of flexor extensor function.Clinical data included repairing soft tissue defects of the forearm, observation of the muscle flap, flap survival and follow-up results.Results All flaps survived in six cases, including one case of postoperative 2d proximal flap where arterial crisis occurred.One case of distal small necrosis healed after dressing change.The remaining four cases were healed by first intention.After the survival, the tendon in the wrist was adhered and loosened again.After＞1 years follow-up, the fingers could be flexed at different degrees.Conclusion The free gracilis muscle flap combined with the upper medial flap of the knee can improve the.flexion and extension function of the affected limb and repair the large area of soft tissue defect of the forearm.