【摘要】 <正>软组织缺损的修复是创伤修复外科的重要课题,修复事故和外伤造成的急性创面,重建糖尿病和血管病变等造成的慢性创面,以最终实现组织缺损的修复、伤残肢体的保留和功能重建。临床上,软组织缺损的形态和性质林林总总,使经治医师面临严峻的考验。因此,选择和实施任何一个治疗手段都必须周到细致、三思而行,诚如业内一位大家所说的:衡量一个重建手术是否成功,不仅要看措施的安全性,更要看它能不能恢复肢体的外形和功能,同时避免对供区的伤害[1]。这就要求临床医生具备对软组织缺损进行分析判断、作更多还原

【Abstract】 Repir of soft tissue defects takes an important role in the field of traumatic repairative surgery, including repair of the injuries and accidents resulted acute wounds, reconstruction for chronic wounds caused by diabetes and vascular diseases, salvage and functional reconstruction of the injured limbs. The repair of traumatic soft tissue defects of the extremities needs overall considerations on the evaluation, methods, principle, decision making and timing. The evaluation consists of the local condition of the injured limb, as well as the general condition, expectation value to the treatment, and the economic and psychological endurance capacity to the multiple reconstructive operations of the patients. Clinically available methods include VAC( vacuum assisted closure) technique, skin substitutes, skin graft, plasty of local skin flap, skin expender, pedicled transposition or transplantation of axial tissue flaps, neurofasciocutaneous or perforator flaps. The principles of repair of soft tissue defects are to use the like tissues to repair the defects, to reduce the damage to the donor sites, to reach the goals in both the functional and cosmetic outcome, to plan the operation carefully and comprehensively. The decision making can be done following the concept of "reconstruction ladder", by which the surgical procedures are selected gradually from "the simple" to "the complex". However, with the advanced technique in hands, the surgeons may start with "the best" rather than "the simplest" to repair the soft tissue defects, as long as it is indicated no matter how difficult it might be. As to the timing, the soft tissue defect is repaired the earlier the better, of cause safety and effectiveness are the prerequisite to do this. A successful microsurgical repair can make full use of the tissues spared from the injury to save the injured limb and to reconstruct its function thus to shorten the treatment process, to relieve the pain of the patient and to reduce his or her economic burden as well. However, if a repairative procedure was done to repair a chronic wound in a harry without an adequate control of infection, the result would be opposite to the expected or even lead to a disaster. In short, when soft tissue defect is to be repaired clinically, a suitable individualized operative plan should be made according to the concrete situation of the defect, and, to be used are only the techniques, which surgeons in charge are familiar to and good at, so as to guarantee the success of the operation and to benefit the patients finally.更多还原