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Soft-tissue injury management and flap reconstruction for mangled lower extremities

机译：下肢畸形的软组织损伤管理和皮瓣重建

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摘要

The treatment for mangled lower extremities poses a clinical challenge for orthopaedic surgeons. The complexities of soft-tissue injury combined with open fractures and osteomyelitis have frequently resulted in amputation of the lower extremity. The current advances in soft-tissue flap reconstruction techniques have significantly improved the results of limb-salvage attempts. Understanding the reconstructive ladders around the zone of injury, debride-ment, timing and nuances of techniques regarding skin graft, local and distant flaps and microsurgical reconstruction is necessary to complete limb salvage in a timely and appropriate fashion. Various soft-tissue flap applications have been described, including emergent flow-through flap, acute soft-tissue flap, acute combined soft-tissue and bone flap, pedicle gastrocnemius/soleus flap, pedicle sural artery flap, soft-tissue flap for chronic osteomyelitis, composite osseous-myocutaneous flap for chronic osteomyelitis and free functioning muscle flap for functional reconstruction of mangled lower limbs. Clinical experience of 850 flaps reconstructions for mangled lower limbs in both acute and chronic stages has revealed that adequate application of flap technique was able to achieve quite acceptable results. This article provides a comprehensive review of the soft-tissue injury management and flap reconstruction for mangled lower limbs.
机译：下肢畸形的治疗对整形外科医生提出了临床挑战。软组织损伤的复杂性加上开放性骨折和骨髓炎经常导致下肢截肢。软组织皮瓣重建技术的最新进展已大大改善了肢体抢救尝试的结果。了解有关伤口，清创，时机和细微差别的有关皮肤移植，局部和远侧皮瓣以及显微外科手术重建技术的阶梯，对于及时，适当地完成肢体挽救是必不可少的。已经描述了各种软组织瓣的应用，包括急诊流通性皮瓣，急性软组织瓣，急性软组织和骨瓣联合，蒂腓肠肌/比目鱼瓣，蒂腓肠动脉瓣，慢性骨髓炎的软组织瓣，用于慢性骨髓炎的复合性骨-肌皮瓣和用于下肢畸形功能重建的自由功能性肌皮瓣。在急性和慢性阶段对下肢畸形的850个皮瓣重建术的临床经验表明，皮瓣技术的充分应用能够取得相当令人满意的结果。本文全面介绍了下肢畸形的软组织损伤处理和皮瓣重建。

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