交通伤四肢复合组织缺损的组织瓣移植修复

Clinical repairing complex defect of soft tissue and bone in limbs caused by traffic accident

目的探讨游离组织瓣移植联合应用外固定器固定骨、关节用于修复交通伤四肢组织缺损伤的临床效果。方法对上肢和下肢交通伤造成骨、关节合并软组织、皮肤缺损等病例共36例，应用游离组织瓣移植，包括骨皮瓣、肌皮瓣、皮瓣移植，同时采用A—O管状外固定器、单侧多功能外固定器及单侧踝关节外固定器行骨关节外固定，加速骨质愈合。结果56例移植皮瓣全部成活，骨关节缺损愈合良好，术后上肢3～6个月、下肢6—8个月拆除外固定器，肢体功能恢复满意，无畸形及骨不连接。结论应用组织瓣移植同时以外固定器固定骨关节对交通伤肢体组织的复合性缺损进行修复和重建，具有骨关节固定简单可靠．肢体及移植组织损伤小．便于观察血运，对肢体交通伤功能得以早期训练以及护理便利起积极作用。

Objective To report the clinical result of repairing complex tissue defect in limb caused by traffic accident using both tissue flap transplantation and external fixer. Methods The vascular tissue flap ineluding bone flap and muscular flap to repair the complex tissue defection（soft tissue, bones, joints） in forearm, hand, leg, ankle and foot were applied in 36 cases. At the same time in surgery, injured bones and joints were fixed by external fixer for stabilizing and accelerating cure. Results All 56 eases were applied successfully with transplanted tissue combined with external fixation. The external fixers were moved away about 10-16 weeks（upper extremity） or 6-8 months（lower extremity） later and all the eases reeovered satisfactorily. Conclusion It is a reliable method for repairing the complex tissue defection in the limb caused by traffic accident by external fixer of traumarology and microsurgery technique. And it is also characterized as a minor injury method on transplanted bones, enables early exercise for joints, convenient observation of flap circulation and easy nursing.