Bipediküllü fibular flep ile tibia rekonstrüksiyonu
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Tarih
2016
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info:eu-repo/semantics/openAccess
Özet
Tibia kemik kayıpları konjenital, enfeksiyon, tümöral oluşumlar ve travmalara bağlı olarak gelişebilir. Ekstremite kaybını önlemek için tibial kemiğin rekonstrüksiyonu şarttır. Rekonstrüksiyon için, distraksiyon osteogenezis, otojen kemik greftleri veya kemik flepleri kullanılabilir. Tibia yerine geçebilecek büyüklükte ve dayanıklılıkta otojen bir kemik bulmak oldukça zordur. Özellikle büyük tibia defektlerinde fibula kemik flebi rekonstrüksiyonda sıklıkla kullanılır. En büyük dezavantajı kalınlığının yeterli olmaması sebebi ile stres kırıklarına maruz kalabilmesidir. Burada sunulan olguda 22 yaşında sağ tibiada Gustilo tip III yaralanması olan hastanın 15 cm boyutundaki tibial kemik ve cilt-yumuşak doku defekti vardı. Aynı bacaktan hazırlanan bipediküllü fibula filebi ile onarım yapıldı. Cilt defekti örtümü için serbest anterolateral uyluk flebi (ALT) ile kapatıldı. Fibula flebi başarılı oldu. ALT flebi ise 72. saatte kullanıldı. Fibula üzeri ikinci seans uygulama ile kısmi kalınlıkta cilt grefti ile kapatıldı. Hastanın 12 aylık düzenli takibinde fibulaya kontrollü yük uygulandı. X-ray görünümünde fibula tamamen tibiaya adapte olmuş ve kalibrasyonu orijinal tibia çapının ¾ seviyesine ulaşmış olduğu görüldü. Her iki ekstremite boyu eşitti. Hasta desteksiz şekilde ayakta durabiliyor ve yürüyebiliyordu. Cerrahinin süresinin kısa olması, güvenilir ve dönor alan morbiditesinin düşük olması tekniğin avantajı iken kalibrasyon zayıflığına bağlı stres kırıklarına karşı dayanıksız olması dezavantajıdır
Tibial defects can be caused by trauma, congenital, osteomyelitis, or cancers. The tibia is the main bone for bearing the body. It is a big bone, and the difficulty of the reconstruction of tibia is importance to repair it. The fibular bone is a good provider for repairing the tibia defects. Generally, the repair was planned be a free vascularized flap. The most important disadvantage is the low calibration. In early age in particular, the original thickness of the tibia is reached after the surgery with a good follow-up process and rehabilitation. In this case; a 22-year-old female patient had a multi-part post-traumatic fracture of the left tibia and was administered to our plastic surgery inpatient clinic. The bone defect was reconstructed with a bipedicle fibular flap taken from the same leg. The fibula was embedded into the medulla with a screw plate, and fixation was applied with an external fixator. Wherefore the loss of skin, skin flap of fibula bottomed of perforators was not used. A vascularized anterolateral thigh flap, which was obtained from the other leg, was used to reconstruct the skin defect. One year after surgery, the bone viability was perfect. The integrity of the skeleton was created without shortening the leg. The rehabilitation of the patient was continued for repowering and resizing the fibula up to tibia. In this case report, we wanted to share our experience for repairing the tibia defect with using a bipedicle fibular flap
Tibial defects can be caused by trauma, congenital, osteomyelitis, or cancers. The tibia is the main bone for bearing the body. It is a big bone, and the difficulty of the reconstruction of tibia is importance to repair it. The fibular bone is a good provider for repairing the tibia defects. Generally, the repair was planned be a free vascularized flap. The most important disadvantage is the low calibration. In early age in particular, the original thickness of the tibia is reached after the surgery with a good follow-up process and rehabilitation. In this case; a 22-year-old female patient had a multi-part post-traumatic fracture of the left tibia and was administered to our plastic surgery inpatient clinic. The bone defect was reconstructed with a bipedicle fibular flap taken from the same leg. The fibula was embedded into the medulla with a screw plate, and fixation was applied with an external fixator. Wherefore the loss of skin, skin flap of fibula bottomed of perforators was not used. A vascularized anterolateral thigh flap, which was obtained from the other leg, was used to reconstruct the skin defect. One year after surgery, the bone viability was perfect. The integrity of the skeleton was created without shortening the leg. The rehabilitation of the patient was continued for repowering and resizing the fibula up to tibia. In this case report, we wanted to share our experience for repairing the tibia defect with using a bipedicle fibular flap
Açıklama
Anahtar Kelimeler
Cerrahi
Kaynak
Turkish Journal of Plastic Surgery
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Scopus Q Değeri
Cilt
24
Sayı
1
