Application of key technique on the reservation and function reconstruction of a leg with delayed necrosis in all intermuscular vessels / 解放军医学杂志

ABSTRACT

Objective To establish an effective technique in reservation and function reconstruction of a leg, in which all the muscles except gastrocnemius necrosed induced by the delayed necrosis of all the intermuscular vessels, the foot was linked only by skin, fascia and tibia. Methods The leg was linked with foot only by the skin, fascia, caput mediale of gastrocnemius and tibia when all the muscles, intermuscular vessels and fibula were removed. The direct island flap of tibialis posterior artery was cut from the healthy limb and used to cover the 4/5 length and 1/3 circumference of bone-fascia raw surface, then to anastomose the both arteries of the flap and the caput lateral gastrocnemius when dividing the pedicles. As soon as the raw surface healed, fuse the ankle in the functional situation and fix the flexor and extensor tendon in the proper situation. Results With sufficient blood supply from the skin and fascia of the flap, the raw surface healed soon, the severe ischemia pain relieved, and the circulation and sensation recovered gradually. The crutching and walking function of the leg reconstructed at last. Conclusion When all the necrotic intermuscular vessels and muscles except caput mediale of gastrocnemius were removed, the necrosis may be delayed by means of reticular collateral circulation among skin, deep and superficial fascia and tibia of the injured limb. However, the blood supply is very little, the severe ischemia wound and ischemia pain can't be healed. Through the tibialis posterior artery direct island skin flap of the healthy leg to cover the dystrophic wounds, the blood supply of the leg can be improved. As a result, the leg survives and its function is reconstructed, and an eternal axial-pattern artery for the wound leg through arteries anastomosis is rebuilt.