单臂外固定支架联合腓肠肌内侧头肌皮瓣治疗胫腓骨骨折合并大面积皮肤撕脱伤

Single-arm External Fixation Frame Combined with Medial Head of Gastrocnemius Muscle Musculo-cutaneous Flap for Treating of Tibiofibular Fracture with Extensive Skin Avulsion

目的探讨单臂外固定支架联合腓肠肌内侧头肌皮瓣治疗胫腓骨骨折合并胫前大面积皮肤撕脱伤的疗效。方法18例患者先进行急诊清创,采用单臂AO外固定支架固定骨折、腓肠肌内侧头肌皮瓣局部旋转覆盖外露胫骨。撕脱的皮肤修成全厚皮片回植供皮区,其中5例仍有缺损,另取同侧大腿全厚皮片移植。结果均无感染,15例旋转皮瓣完全成活,2例皮瓣远端表皮坏死,经换药治愈,1例皮瓣远端全层坏死,经植皮治愈。撕脱皮片回植13例成活,5例小部分坏死,其中3例经换药治愈,2例经中厚皮片植皮愈合。5例大腿皮片完全成活。平均随访19.5（10～36）个月,骨折平均愈合时间4（3.5～6）个月。所有患者行走正常,3例膝关节屈伸活动受限,4例踝关节屈伸受限。结论采用单臂外固定支架联合腓肠肌内侧头肌皮瓣治疗胫腓骨骨折合并胫前大面积皮肤撕脱伤,疗效肯定。

Objective To evaluate the effect of single-arm external fixation frame combined with medial head of gastrocnemius muscle musculo-cutaneous flap for treating of tibiofibular fracture with extensive skin avulsion.Methods 18 cases of tibiofibular fracture with extensive skin avulsion were underwent urgent debriedement,fracture fixation by AO single-arm external fixation frame,and covering the exposed tibia through transferring of medial head of gastrocnemius muscle musculo-cutaneous flap.The full-thickness skin graft,which dressed by avulsed skin,was replanted to close the skin donor site wounds.Ipsilateral thigh skin graft was implanted in 5 cases because of donor site exposure.Results The transferring flaps were survived in 15 cases,distal flap necrosis was found in 3 cases（2 in epidermis and 1 in full-thickness）.The avulsed skin graft was survived in 13 patients,partial necrosis occurred in 5patients.All the 5 cases of ipsilateral thigh skin graft were survived.All cases were followed up for 10～36 months,and the fractures were re-unioned in 3.5～6 months.18 cases walked normally,but limitation of flexion-extension was found in 3 knees and 4 ankles.Conclusion Single-arm external fixation frame combined with medial head of gastrocnemius muscle musculocutaneous flap is an effective management for treatment of tibiofibular fracture with extensive skin avulsion.