应用腓肠神经远端筋膜蒂皮瓣一期修复胫腓骨远端严重开放骨折

Treatment of severe open distal fibula and tibia fracture following up application of Sural neuro-veno-fasciocutaenous flap

目的探讨胫腓骨远端严重开放性骨折应用腓肠神经远端筋膜蒂皮瓣一期创面修复的疗效。方法 2003年4月~2008年12月,我们收治胫腓骨远端严重开放性骨折50例,骨折类型：GtustiloⅢB型45例,GtustiloⅢC型5例。所有患者均施行急诊彻底清创,骨折复位后应用外固定支架固定20例,拉力螺钉内固定10例,钢板螺钉内固定20例,之后施行腓肠神经远端筋膜蒂皮瓣一期修复创面。结果皮瓣存活42例,远端部分皮肤浅表坏死8例,骨折愈合47例,骨折不愈合3例,骨折愈合时间：3~9个月,平均6个月。无骨髓炎发生。结论胫腓骨远端严重开放性骨折经清创后,应用腓肠神经远端筋膜蒂皮瓣一期创面修复可获得满意疗效。

Objective To explore the clinical outcome of severe open distal fibula and tibia fracture following for direct repairing with Sural neuro-veno-fasciocutaenous flap.Methods 50 cases with open distal fibula and tibia fracture included GtustiloⅢB 45 cases and GtustiloⅢC 5 cases were treated in our hospital from Apr 2003 to Dec 2008.All patients were given emergency debridement.External fixator included external faxtors in 20 cases,compressive screw fixation in 10 cases and plate and screw fixation in 20 cases after fracture reduction.Tissue defect has been repaired by Sural neuro-veno-fasciocutae-nous flap.Result Flaps were survived completely in 42 cases except 8 distal part superficial skin necrosis.The fracture healing were in 47 cases and nonunion in 3 cases.The fracture healing time were from 3 to 9 months on average of 6 months.None osteomyelitis was occurrenced.Conclusion The effective outcome were gained with Sural neuro-veno-fasciocu-taenous flap to repair the severe open distal fibula and tibia fracture with soft tissue defect after emergency debridement.