吻合血管的游离肌肉瓣加网状皮片移植修复胫骨骨折合并骨外露及感染创面

Microvascular free muscle flap reconstruction of soft-tissue defects with bone exposure after the distal tibial fracture

目的介绍应用吻合血管的游离肌肉瓣加网状皮片移植修复胫骨骨折合并骨外露及感染创面的新方法。方法26例胫骨骨折合并骨外露及感染创面患者依伤情选择手术时机,5例采用一期吻合血管的游离肌肉瓣加网状皮片移植覆盖骨外露创面；6例急诊清创术后2周行二期修复；其余15例入院前胫骨远端感染严重,均采用二期肌肉瓣加网状皮片移植覆盖骨外露创面。结果26例中22例术后肌肉瓣及皮片全部成活；2例皮片部分坏死,2例创口延迟愈合,经换药均二期愈合。随访10～24个月(平均18个月),皮片色泽、质地、弹性均良好,无瘢痕挛缩。骨折均已愈合。结论肌肉瓣血运丰富,是修复胫骨远端感染及骨外露创面的理想方法,比较适合覆盖大面积软组织损伤合并骨外露创面和小腿远端慢性窦道及慢性骨髓炎骨外露创面。

Objective To present a method to treat soft tissue defects with bone exposure after the distal tibial fracture. Methods Twenty-six patients who had suffered from the distal tibial fracture complications leading to exposure of the bone or fixation material sought medical help in our department. The internal fixation material was removed and radical revision of dead and infected tissue was carried out in all cases. Five of the 26 cases were treated using a free microvascular muscle flap and the mesh skin graft by one stage. Twenty-one of them were repaired with the same method by two-stage. Results Follow-ups were 10 to 24 months. The microvascular reconstruction was successful in 22 patients. Two of the 26 cases had partial necroses of the skin graft, and the other two cases had delayed wound healing. All the fractures united. Conclusion Microvascular free muscle flap reconstruction of the leg is regarded as a reliable method to treat legs with massive soft-tissue defects or defects with bone exposure and chronic infection or fistulation at the distal leg.