摘要
目的探讨外固定器在前臂复合组织缺损皮瓣修复重建中的应用价值。方法2005年5月至2008年12月，共收治创伤所致前臂复合组织缺损，且联合应用外固定器行皮瓣修复治疗的患者17例，其中男性11例，女性6例；年龄19～47岁，平均25．6岁。所有病例均有深部肌腱、骨骼外露。皮肤缺损面积7cm×4cm～19cm×9cm，全部采用带蒂皮瓣移植修复，皮瓣面积10cm×6cm～20cm×15cm。带蒂皮瓣蒂端缝合成管状，应用外固定器保持蒂部位置。固定针分别位于尺骨和髂骨者5例，位于桡骨和髂骨者12例。固定时间3～8周，平均5．1周。结果所有患者均获随访，随访时间3～20个月，平均11．3个月。带蒂皮瓣全部成活，无压疮、腋窝糜烂、筋膜间隔综合征及骨髓炎等发生。术后4～6周断蒂，1例断蒂端存在表浅感染，经换药后创面愈合，其余16例断蒂后创面顺利愈合。骨折愈合时间8．5～15周，平均13．5周。二期皮瓣整形与功能重建者11例次。所有患者手及前臂功能恢复满意，感觉恢复至S3～S4级（1954年英国医学研究会感觉恢复分级标准），手外在肌和腕部肌肉肌力约Ⅳ～Ⅴ级。11例返回原工作岗位，6例满足日常生活需要。结论在前臂复合组织缺损带蒂皮瓣修复中，应用外固定器可稳定地保持蒂部位置，代替石膏贴胸位固定，减少皮瓣血管痉挛的发生，便于皮瓣观察、护理和换药，利于前臂各关节主动及被动活动，最大程度恢复肢体功能。
Objective To discuss the curative effect of the external fixator for complex tissue defect in the forearm. Methods From May, 2005 through December, 2008, the external fixtors were used in 17 patients to treat the complex tissue defect in the forearm caused by trauma. There were 11 male and 6 female, with a mean age of 25.6. All patients were accompanied with the exposure of tendon, muscle or screw. The skin defect ranged from 7 cm×4 cm to 19 cm×9 cm. All patients underwent pedicle flap repair. The flap ranged from 10 cm×6 cm to 20 cm×15 cm. The proximal pedicle of the flap was sutured into a tubular. The position of the pedicle was fixed by the external fixator. The pin was at the ulnar and the iliac （ n = 5 ）, and the radius and the iliac （n = 1：2）. The immobilization lasted 3 to 8 weeks, 5.1 weeks in average. Results All patients were followed up for 3 to 20 months, 11.3 in average. All pedicle flaps survived with no pressure ulcer, or no erosion in the axilla. No compartment syndrome or osteomyelitis occurred. Four to six week after surgery, the pedicle was cut. Infection occurred at the cutting end in 1 patient. The wound healed after addressing. The wound in the other 16 patients healed successfully. The fracture of the ulnar and the radius healed 8.5 or 15 weeks after surgery, 13.5 weeks in average. Eleven patients underwent second stage reshape and function restoration. The function of the hands and forearms recovered satisfactorily. Eleven patients returned to their work. Six patients can live with basic function for living. Conclusions The external fixator used for complex tissue defect in the forearm can keep the position of the pedicle, replacing plaster fixation. It can reduce the incidence of flap and vessel spasm, and get good outcomes.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2009年第13期1014-1016,共3页
Chinese Journal of Surgery
关键词
外固定器
前臂
创伤和损伤
外科皮瓣
External flxators
Forearm
Wound and injuries
Surgical flaps
