复合组织瓣移植修复下肢创伤后骨髓炎伴骨及软组织缺损

Free composite tissue graft in treatment of traumatic osteomyelitis combined with bone and skin defect in lower limb

目的总结不同形式骨皮瓣移植修复下肢创伤后骨髓炎合并骨及软组织缺损的方法和疗效。方法2001年6月至2006年2月，对38例下肢创伤后骨髓炎合并骨及软组织缺损病例，在创面彻底清创的基础上，根据下肢创面骨缺损的程度、皮肤缺损面积以及复合组织瓣的特点，选择复合骨皮瓣18例、组合骨皮瓣14例、联合（体）骨皮瓣6例移植于受区，一期修复股骨、胫骨、踝关节、跟骨、跖骨等部位骨髓炎并骨及软组织缺损，观察术后皮瓣成活情况、骨折愈合情况及骨髓炎愈合情况。结果术后随访8-56个月，平均30个月。皮瓣全部成活，伤口Ⅰ期愈合35例，Ⅱ期愈合3例；移植骨全部愈合，愈合时间2-14个月，平均4．6个月；骨髓炎6个月后复发2例，经二次病灶清除后愈合。结论综合考虑下肢创伤后骨髓炎合并骨及软组织缺损患者整体及患肢情况，对病灶区彻底清创，选择多种形式的复合组织瓣移植，可一期修复下肢骨及软组织缺损，提高机体的抗感染能力，缩短疗程，提高骨髓炎的冶愈率。

Objective To describe the method and clinical effects of various .kinds of osteccutaneous flaps graft in treatment of traumatic osteomyelitis in lower limb combined with bone and soft tissue defect. Methods From June 2001 to February 2006, 38 patients with traumatic osteomyelitis in lower limb combined with bone and soft tissue defect were included in this study. There are 25 males and 13 females, with an average age of 32.5 years（range 18-68 years）. After debrldement of bone were carried out, 18 cases of free composite osteocutaneous flap, 14 cases of free component or 6 cases of united （conjoined） osteocutaneous flap were carried out to repair the bone and soft tissue defect of femur, tibia, ankle joint, calcaneus, metatarsal bones according to the bone or soft tissue defect area and the characteristic of different flaps. was observed. Results All of the patients had been followed Clinical outcome of these osteocutaneous flaps , up for 8-56 months with an average of 30 months. All of the flaps survived. The wounds had healed in 35 cases; and 3 patients who experienced wound disunion needed wound dressing to alleviate symptoms. All grafted bone had healed in 2-14 months with an average of 4.6 months. The osteomyelitis reoccurred in 2 cases 6 months later had achieved healed by nidus clearing finally. Conclusion The condition of patient and the affected limb should be considered fully before operation. The reconstruction operation includes debridement of bone and various kinds of osteocutaneous flaps graft. The technique can be used to repair the bone and soft tissue defect and control the infection in the lower limbs.