Reconstruction of the Extremities with Vascularized Tissue Transfer: Experience of 100 Cases

由於近代顯微血管手術的迅速發展，以及在臨床上廣泛且並遍的使用，許多嚴重外傷性殘缺肢體或病態器官得以重建及保存，進而改善並提提高了病患的生活品質。我們從民國72年至79年中，共完成100例帶血管莖組織皮瓣手術，用於上、下肢外傷及非外傷組織的重建，其中57例為自由皮瓣，43例為逆轉皮瓣。這些皮瓣使用於小腿外傷重建的病例最多，而絕大多數是由工業傷害或是機車車禍所造成。我們共使用9種皮瓣，其中包括多種的複合組織重建。前臂皮瓣(30例)為我們最常使用者，依次為足趾皮瓣(21例)及腓骨皮瓣(17例)。重建手術大部份是在受傷後3天到2個月之內完成。手術存活率分是94.7%(自由皮瓣)及93%(道轉皮瓣)。術後合併症以感染為最常見。100例中唯被截肢者是由於再發性骨髓炎,但其皮瓣仍舊存活。由我們的經驗發現：第一，帶血管莖組織皮瓣的臨床價值是可以肯定的；第二，使用安全性高、容易操作的皮瓣，其組織存活率會提高；第三，面對術後問題皮瓣，做早期積極的探察手術，以減少不良結果的發生；第四，重建手術在外傷後早期實行，可減少術後感染率。

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並列摘要

A retrospective study of 100 consecutive vascularized tissue transfers for reconstruction of the upper and lower extremities was made. This consists of 57 free flap transfers and 43 reversed flap transfers. Soft tissue coverage for acutely traumatized lower leg was the most frequent indication. Industrial injury and motorcycle accident were the main cause of the defects. Nine types of vascularized flap were employed in this series, with variety of tissue composite being transferred. Radial forearm flap (30 cases) represents the most commonly selected donor site, followed by toe flap (21 cases) and peroneal flap (17 cases). Majority of the reconstruction were performed between the period of 3 days and 2 months after injury. The survival rate for free tissue transfer was 94.7%, and for reversed flap transfer was 93% in our patients. Postoperative infection was a common complication, with the unique one amputation due to recurrent osteomyelitis following a successful flap transfer. No mortality attributed to our flap surgery. We are convinced that vascularized tissue transfer is a valuable armamentarium in reconstruction of complicated limb trauma, while simple and easy accessible flap increases tissue survival rate.

並列關鍵字

free flap ； reversed flap ； limb reconstruction

國際替代計量

Reconstruction of the Extremities with Vascularized Tissue Transfer: Experience of 100 Cases

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