Survival of the Fibula Osteoseptocutaneous Flap with Thrombosis of Peroneal Veins on Harvesting-Case Report

對於整形重建外科醫師而言,發生於嚴重外傷後的下肢開放性骨折的骨頭缺損處置仍然是一大挑戰。對於下肢外傷的病人，當同時有骨頭及軟組織缺損發生時可能需要用骨皮皮瓣來重建。然而我們在取腓骨骨皮皮瓣的時候，遭遇到了腓靜脈栓塞的情形。在皮瓣取下之前，我們並未注意到對側下肢有受傷，而且血管攝影也未例行照射而發生了這項意外。這裡我們報告一個用骨髓來引流腓骨骨皮皮瓣靜脈血的情形。下面有兩個重要因素使大塊的腓骨骨皮皮瓣存活：(1)在動脈迴路及引流靜脈途徑的設計，腓骨骨皮皮瓣內的腓動脈兩端分別吻合到了前脛動脈及大隱靜脈分枝來形成一個動脈流通的機制。這構成了一個不中斷的動脈迴路。(2)主要的靜脈回流是靠骨髓。雖然這個皮瓣一開始有一點靜脈鬱血及表皮壞死，骨頭及大部分的軟組織最後都有存活下來。X光攝影及骨膜豐富血流證實了骨質的存活及連接骨頭處逐漸的癒合。病患在九個月後能用患肢支撐部分體重站立起來及行走。

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並列摘要

Management of bone loss that occurs after severe trauma of open lower extremity fractures remains a challenge to reconstructive surgeons. For patients with lower limb trauma, an osteocutaneous flap may be required when there are simultaneous defects of bone and soft tissue. We present a case where thrombosis in the peroneal veins of the fibula osteoseptocutaneous flap was encountered during the harvest. The mistake happened as the injury to the donor leg was inconspicuous and angiography was not routinely performed before harvesting. Here we describe a clinical situation in which bone marrow was used for drainage of venous blood in a free fibula osteoseptocutaneous flap. There were two important factors accounting for the survival of this large fibula osteoseptocutaneous flap. (1) In this flap, the arterial circuit was designed so that the two ends of the peroneal artery in the fibula flap were anastomosed to the anterior tibial artery and a branch of the great saphenous vein, to establish the flow-through mechanism. This constituted an uninterrupted arterial circulation. (2) The major venous drainage was through bone marrow. Although there was initial venous congestion and necrosis of the skin paddle, bone and most of the soft tissue survived. Roentgenogram and periosteal abundant vascularity demonstrated bone survival and gradual healing. After rehabilitation, the patient can stand up and walk with the traumatic leg tolerating partial weight bearing after 9 months.

並列關鍵字

bone and soft tissue defect ； flap salvage ； venous drainage of free flap ； bone Marrow

國際替代計量

Survival of the Fibula Osteoseptocutaneous Flap with Thrombosis of Peroneal Veins on Harvesting-Case Report

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