下肢外傷後の軟部組織再建法の検討

Abstract

In extensive injuries of the lower limbs, skin closure is very difficult. At Fukuoka University Hospital, we examined 32 cases which had undergone reconstructive surgery involving skin and soft tissue defect of the lower extremity between June 1988 and August 1990. Patients include 24 males and 8 females whose mean age was 38.3 years. Causes: 12 cases involved in open fractures, 9 cases of softtissue injuries, 5 cases with chronic osteomyelitis, 3 in burn-ulcer victims, 2 ulcered from I. V. drip infusion, and 1 involved in a skin flap donor site. Reconstruction methods varied from fascio-cutaneous flaps in 15 cases, including cutaneous arterial flaps and septo-cutaneous. 12 cases had split thickness skin grafts. 6 cases were treated with conventional local skin flaps. 3 cases had micro-vascular free flap surgery. One case had cross leg flap. Postsurgical complications included partial skin necrosis in half of the conventional local skin flap method cases, necessitating another operation. One of the three free flap method cases slough totally due to thrombosis of the anastomosis side of the vein. Only one of the 15 fascio-cutaneous flaps suffered from partial necrosis. We concluded that the most convenient, most successful, fastest healing, and safest method is the fasciocutaneous flap method.