摘要
目的观察以皮瓣覆盖下肢严重开放骨折的疗效,分析常见的并发症及手术时机。方法自1999年12月～2004年4月间,41例患者,42侧下肢,共43个皮瓣。Ⅲb型骨折38个肢体,Ⅲc型骨折2个肢体,足的截肢性损伤2个肢体。男34例,女7例,年龄14～75岁,平均38.3岁。损伤部位33例在胫骨,10例位于足和踝。创面面积4～450cm2(平均71cm2)。本组病例受伤至皮瓣手术平均18.9d(3～43d),游离皮瓣31例(游离股薄肌皮瓣14例,游离背阔肌皮瓣8例,游离背阔肌加肋骨2例,游离腹直肌皮瓣7例),有蒂皮瓣12例(小腿外侧皮瓣9例,腓肠肌瓣2例,比目鱼肌肌瓣1例)。结果1例游离背阔肌皮瓣失败,骨不愈合4例(9.52%),26例患者术前创面细菌培养阳性,4例出现深部软组织感染(9.52%)。我们将术前细菌培养呈阳性的患者和术前细菌培养呈阴性患者的手术时间做了比较,两组患者受伤至皮瓣手术的平均时间分别为22.4d和8.33d,两者有显著性差异。结论提倡合理使用抗菌素,早期覆盖创面及植骨。端-侧吻合是适用和安全的。
Objective To observe the clinical effects of flap coverage in treatment of severe open injuries of lower limb and to analyze common complications and the timing of flap coverage. Methods Between 1999 and 2004, a total of 43 flap grafts were done for 42 lower limbs in 41 patients with such injuries at our institutions. The cases were reviewed retrospectively. There were 38 ⅢB and 2 ⅢC fractures, and 2 amputations of the forefoot. 34 were males, and 7 females. The average age of the patients at the time of injury was 38 years (range, 14 to 75 years). There were 33 injuries to the tibia, 10 to the ankle and foot. The soft tissue defects ranged from 4 to 450 cm2 (mean 71 cm2) in size. The time interval from injury to flap surgery ranged from 3 to 43 days (mean, 18.9 days). 31 were free (14 gracilis, 8 latissimus dorsi, 2 latissimus dorsi with rib, and 7 rectus) and 12 were pedicled flaps (9 lateral leg, 2 gastrocnemius, 1 soleus). Results There was 1 failure involving free latissimus dorsi flap. There were 4 nonunions (9.52%). Preoperative wound cultures were positive from 26 patients. There were 4 cases of deep soft tissue infection (9.52%). A distinct difference existed in duration from injury to flap surgery between pre op culture positive group (22.4 days) and pre op culture negative group (8.33 days). Conclusion Early flap coverage before colonization of bacteria, appropriate antibiotic administration, early bone grafting, and safe and practical ETS (end to side) technique are advocated.
出处
《中华创伤骨科杂志》
CAS
CSCD
2004年第10期1116-1117,1121,共3页
Chinese Journal of Orthopaedic Trauma
关键词
下肢
开放性骨折
皮瓣覆盖
端-侧吻合技术
Fracture, open
Free flap
Pedicled flap
End to side technique (ETS)
