目的：探讨跨区域联合皮瓣修复四肢巨大面积复合组织缺损的临床效果。方法：总结5年来四肢超大面积复合组织缺损病例34例，分别采用早期创面VSD覆盖后二期修复16例；两块皮瓣分期组合修复13例；跨区域联合皮瓣修复5例。结果：采用创面VSD覆盖后创面二期植皮或皮瓣修复平均住院69 d，后期瘢痕增生严重，功能重建困难。两块游离皮瓣串联或并联修复平均住院45 d，其中2例术后一块皮瓣坏死，二期腹部带蒂皮瓣修复，后期功能重建后恢复较满意。跨区域联合皮瓣修复平均住院23 d，在三种术式中其后期外形、功能恢复最好。结论：跨区域联合皮瓣游离移植修复四肢巨大面积复合组织缺损，同时一期部分功能重建，临床效果满意。%Objective:To explore the effectiveness of cross-regional flap in repair of ultra-long complex tissue defects in limbs.Method:The cases of large area of composite tissue defect in limbs in the past five years were summarized.The wound of 16 cases were covered firstly by the VSD then repaired in the second stage,13 cases were repaired by combined piece of skin flap in installment,5 cases were repaired by cross-regional joint flap.A total of 34 cases. Result:The average length of stay was 69 days when using the way of skin graft or skin flap to repair after VSD covering.What’s more,the scar hyperplasia was serious in the later period and function reconstructive became more difficult.The average days in hospital were 45 days when using two series free flaps or parallel free flap to repair.There was a flap necrosis in 2 cases,and abdominal pedicle skin flap was performed to repair,the reconstructive function and recovery were satisfied.The average hospitalization was 23 days when using cross-regional flap to repair and the functional recovery and appearance were the best in these three kinds of operation.Conclusion:It could get a good clinical effect when using free cross-regional flap transplantation to repair large area of composite tissue defect and reconstruct function of limbs.
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