الملخص
Objective To explore the curative effect of anterolateral musculocutaneous flap to repair the soft defect of the lower leg amputation stump which on the verge of reamputation, and preserved the length of leg or the knee joint to improve prosthetic limb function. Methods Four patients with soft defect and bone expose of proxi-mal leg amputation stump were enrolled in this study from April, 2013 to November, 2016. Each patient underwent stump revision using anterolateral musculocutaneous flap, including 3 free musculocutaneous flaps and 1 pedicle mus-culocutaneous flap. The patients were all male with the mean age of 20(8-48) years. The wound was treated debride-ment, and reconstructed on the second stage. Defect area was from 7.0 cm×6.0 cm to 25.0 cm×10.0 cm. Anterolateral musculocutaneous flaps was from 13.0 cm×10.0 cm to 28.0 cm×12.0 cm. The length of preservation tibia stump was from 5.2 cm to 9.4 cm. Results All patients were followed-up from 12 months to 37 months (average, 19 months). All the musculocutaneous flaps survived completely with a soft tissue texture, elastic, and very wear-resisting. The sensory return was determined to be S2in 2 patients, S3in 1 patient and S3+ in 1 patient. The 6-Minute Walk Test:grade Ⅳ in 2 cases, grade Ⅲ in 2 cases; Stanmore movement classification: gradeV in 2 cases, grade Ⅳ in 2 cases. Conclusion The anterolateral musculocutaneous flap maybe is an ideal flap to provid stable coverage for the stump of leg amputation which on the verge of reamputation.
الملخص
Objective To explore the long-time clinical results and effection of free anterolateral thigh musculocutaneous flap for repairing the complex defects involving lateral or medial malleolar of the ankle and heel,especially for reconstructing stability of the ankle joints. Methods Thirteen patients with complex tissue defects,involving lateral or medial malleolar of the ankle and heel,were treated by free anterolateral thigh fasciomusculocutaneous flap.The fascia lata which was involved in the flap was fixed with the adjacent tissue of the recipient area.The descending branches of the lateral circumflex femoral vessels were anastomosed with the vessels in the recipient area.The largest area of the flap was 20 cm × 12 cm.The ankle joint was fixed in functional position with plaster in the early 3 months post-operatively.The following time ranged from 1.5 years to 20 years.The stability of the ankle joint were evatuated with the patients' objective feeling and clinical symptoms and imaging study.Results The stability of the ankle should be protected by external fixation in the early 3 months postoperatively,and was restored at 6 months usually.In all cases,ten cases were followed over 10 years,six cases were followed over 6 years,three cases were followed over 15 years.Though radiological discovering suggesting traumatic esteoarthritis exited in 3 cases with a follow-up more than 5 years,the clinical manifestations were fair and no one need undergo arthredesis. Conclusion Using ant erolateral thigh musculocutaneous flap for reconstructing the complex defects involving lateral or medial malleolar of the ankle and heel repairing stability of the joint and ovoiding off early arthrodosis of the joint is one of the favorable choice,especially for the teen-agers.