带神经营养皮瓣综合治疗胫、腓骨开放骨折合并皮肤软组织缺损的术后护理

Postoperative nursing of open tibial fracture fibula with skin and sole tissue defects patients treated by neurocutaneous flap

目的总结应用外固定架及封闭式负压引流联合带神经营养皮瓣治疗胫、腓骨开放骨折合并皮肤软组织缺损的术后护理及功能锻炼的效果。方法开放性胫、腓骨骨折，患者均行骨折复位外固定架固定，采用封闭式负压引流（VSD）待创面肉芽组织新鲜、感染控制后，用带神经营养皮瓣治疗皮肤软组织缺损，术后予以特殊护理与康复治疗。结果患者术后予以特殊护理与康复治疗，皮瓣顺利成活。患者均获随访，随访时间1—10个月。皮瓣与周围皮肤色泽相似，无臃肿，两点辨别觉6—8mm，术后能穿鞋正常行走，皮瓣受力处无破溃。结论外固定架及封闭式负压引流联合带神经营养皮瓣治疗胫、腓骨开放骨折合并皮肤软组织缺损，术后予以特殊护理与康复治疗，疗效满意。

Objective To summarize the application of external fixation and closed suction drainage combined with tibial neurocutaneous flap, open fracture of fibula skin and soft tissue defects after the effects of care and functional training. Methods Open tibial and fibula open fracture, the patients underwent fracture reduction external fixation, the use of VSD to be fresh granulation tissue, infection control, the use of flaps with neurotrophic lack of treatment of skin and soft tissue loss, postoperative care and rehabilitation to be special. Results Provided special care and postoperative rehabilitation, the flap survived well. Patients were followed up for 1 to 10 months. Color similar to the flap and surrounding skin, no fat, two points discrimination of 6 - 8 mm. Patients can normally walk after surgery, and no ulceration occurred with the force at the free flap. Conclusions External fixation and closed suction drainage combined with neurotrophic flap tibia and fibula open fractures with skin and soft tissue defect, postoperative care and rehabilitation to the special treatment, results were satisfactory.