腓肠神经营养血管肌皮瓣加置管冲洗治疗外踝创伤性骨髓炎

Sural flap transplantation plus catheter irrigation for chronic lateral-malleolus ostoemyelitis

目的报道逆行腓肠神经营养血管肌皮瓣加置管抗生素溶液冲洗在慢性外踝骨髓炎中的应用。方法从2000年3月至2008年3月．共收治外踝慢性骨髓炎17例，为外伤致外踝部开放性骨折治疗不当发展为外踝骨髓炎，将外踝部肉芽创面清理，外踝开窗反复刮除后，采用逆行腓肠神经营养血管肌皮瓣修复创面。皮瓣切取面积最大7cm×11cm。最小5cm×6cm。皮瓣均带有厚约1cm腓肠肌外侧头肌。在复合皮瓣缝合于创面之前．通过正常组织穿刺．放置一无菌硬膜外麻醉管至外踝髓腔内。以便于术后根据细菌培养结果通过该管向骨髓腔内注射细菌敏感抗生素。结果术后皮瓣均成活。通过硬膜外麻醉管注射抗生素1个月后。15例外踝未见红肿、无异常分泌物及温度升高．C反应蛋白检测值降至正常范围，遂拔出硬膜外管。2例皮瓣远端有一约1cm伤口未愈，伤口内有脓性分泌物。再次细菌培养加药敏检测后，调整经管注射药物及加强换药后约1．5个月，伤口闭合．未见再有异常分泌物，C反应蛋白降至正常后，拔除硬膜外管。皮瓣外形满意，功能良好。随访1-8年，未见骨髓炎复发。结论腓肠神经营养血管肌皮瓣加置管冲洗是治疗外踝骨髓炎伴局部软组织缺损的一种简单有效方法。

Objective To describe the method and clinical result of super sural neuromusculocu- taneous flap grafting plus catheter irrigation in the treatment for chronic lateral malleolus osteomyelitis. Methods From March 2000 to March 2008, 17 cases, male lg, femal 3, 21 to 75 years old （average 43-year-old）, were underwent reversed saphenons musculocutaneous island flap after wide excision of lateral- malleolus lesion. The cause of lateral-malleolus lesions was trauma. The smallest flap was 5 cm × 6 cm and the largest was 7 cm × 11 cm. Catheter irrigation was used in all cases. Results Follow-up ranged from 12 to 96 months, average 49 months. After operation,the wounds were irrigated with sensitive antibiotics 1 to 2.5 months（average 49 days）, and all flaps were survived. Except 2 cases, the other 15 were healed in 1 month. The 2 cases were not healed at first stage. According to the lab result, we changed the antibiotic, and in 2.5 months, we took off the catheter. Conclusion To deal with the chronic traumatic lateral-malleolus osteomyelitis, super sural neuromusculocutaneous flap grafting plus catheter irrigation is approprite and effective.