游离腹直肌肌瓣加植皮治愈7例胫骨下段难治性慢性骨髓炎

Free rectus abdominis muscle flap and intermediate split thickness skin graft curing 7 cases with difficult chronic osteomyelitis of the lower tibia

目的:探讨应用游离腹直肌肌瓣+中厚游离植皮治疗胫骨下段难治性慢性骨髓炎的方法和疗效。方法:自2003年5月～2009年12月,采用以腹壁下动、静脉为血管蒂的一侧腹直肌肌瓣游离移植加中厚植皮治疗7例胫骨下端慢性骨髓炎。慢性骨髓炎清创后缺损范围为4cm×5cm～7cm×10cm,切取腹直肌肌瓣的大小为5cm×6cm～8cm×15cm。结果:术后7例移植的腹直肌肌瓣均成活良好,中厚植皮无坏死。随访6月～2年,踝部外形及功能良好,2例患者硬化性骨坏死恢复正常。结论:游离腹直肌肌瓣+中厚游离植皮治疗胫骨下段的难治性慢性骨髓炎具有血运好、抗感染力强和顺应性好等优点,术后踝部外形及功能良好。

Objective To explore the method and effect of free rectus abdominis muscle flap and intermediate split thickness skin graft in treating. Difficult chronic osteomyelitis of the lower tibia. Methods From May of 2003 to December of 2009,7 cases with difficult chronic osteomyelitis of the lower tibia were repaired by use of unilateral free rectus abdominis flap and intermediate split thickness skin graft. After debriding, the defect size ranged from 4cmx5cm to 7cm×10cm. The area of rectus abdominis muscle was from 5cm ×6cm to 8cm×15cm, Results The free rectus abdominis muscle survived completely in the 7 cases. The intermediate split thickness skin graft had not necroses. All patients were followed up 6 months to 2 years after operation. The ankles had good appearances and functions. In 2 cases cirrhosis osteomyelitis recovered. Conclusion Use of free rectus abdominis muscle flap and intermediate split thickness skin graft is a proper option for difficult chronic osteomyelitis of the lower tibia. It has advantages of abundant blood supply, strong anti-infection ability and good compliance. The patients were satisfied with the appearance and functions of the ankles after operation.