游离皮瓣Taylor支架治疗踝周骨与软组织缺损△

Free flap and bone transportation with Taylor spatial frame for bone and soft tissue defects around ankle

摘要:

[目的] 介绍游离皮瓣联合Taylor 支架（taylor spatial frame, TSF） 治疗踝周骨与软组织缺损的手术技术和初步临床结果。[方法] 2016 年1 月—2020 年2 月共治疗踝周骨与软组织缺损16 例患者，一期行彻底清创，清除感染坏死骨与软组织，使用外固定支架临时固定，缺损创面使用负压海绵覆盖。二期根据创面部位、面积和软组织缺损情况及血管条件分别选用游离背阔肌皮瓣、股前外侧肌皮瓣、腓肠肌内侧肌皮瓣对踝周皮肤缺损进行修复。皮瓣成活后三期根据骨缺损范围预设TSF 骨延长及胫距融合构型，术中根据治疗要求，安装固定TSF 并完成截骨。术后1 周根据术前测量的畸形、安装、框架参数制定电子处方，以1 mm/d，分4 次调整的速度，开始骨延长及调整TSF，最终完成牵张成骨和胫距融合。[结果] 16 例患者均获随访，随访时间14~52 个月。术后外固定架总佩戴时间平均（17.3±2.4） 个月，愈合时间平均（14.8±1.4） 个月，总治疗时间平均（17.9±2.2） 个月。末次随访时，胫骨总延长平均（7.5±1.1） cm。按AOFAS 踝及后足评分进行评定：优12 例，良4 例。[结论] 游离皮瓣结合TSF 治疗踝周骨与软组织缺损，可有效修复缺损组织，胫距关节融合成功率高，负重力线恢复好，成功重建下肢功能。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of free flap and bone transportation withTaylor spatial frame (TSF) for bone and soft tissue defects around the ankle. [Methods] A total of 16 patients were surgically treated forbone and soft tissue defects around the ankle from January 2016 to February 2020. In the first stage, complete debridement was performedto remove infected and necrotic bone and soft tissue, temporary fixation was performed with a simple external fixation frame, and the defectwound was covered with vacuum sealing drainage (VSD). In the second stage, according to the wound site, area, soft tissue defect and vascu-lar condition, the free lat dorsal myocutaneous flap, anterolateral femoral myocutaneous flap and medial gastrocnemius myocutaneous flapwere used to repair the soft tissue defect. After the survival of the flap, the bone transportation or tibiotalars fusion with TSF were performedat the third stage according to the extent of bone defects. During the last operation, TSF was installed and fixed according to the require-ments of treatment with osteotomy. One week after the surgery, an electronic prescription was made according to the deformity, installationand frame parameters measured before surgery. The bone transportation with TSF were adjusted at a rate of 1 mm/d per day, divided intofour times, and finally distraction osteogenesis and tibial talus fusion were completed. [Results] All the 16 patients were followed up for 14~52 months, with external frame wearing time of (17.3±2.4) months, the bone healing of (14.8±1.4) months, and the total treatment time of(17.9±2.2) months. At the last follow-up, total tibial lengthening was of (7.5±1.1) cm. The clinical outcome was marked as excellent in 12cases and good in 4 cases based on AOFAS criteria. [Conclusion] Free flap and bone transportation with Taylor spatial frame can effective-ly repair bone and soft tissue defects around the ankle, with high success rate of tibiotalar fusion, good recovery of alignment and successfulreconstruction of lower limb function.