小腿开放性骨折伤口处理

The Managements of Open Leg Fractures

目的 报道开放性小腿骨折伤口闭合的处理经验。方法 清创和处理骨折后,直接缝合伤口时应无张力,否则行减张缝合,创面有软组织,可游离植皮。套状撕脱皮肤可修复成中厚皮片行原位缝合。创面污染重宜延期Ⅰ期闭合。对骨质外露,宜采用筋膜皮瓣,肌(皮)瓣。感染创口需炎症控制后行伤口闭合。结果 新鲜创口128例伤口闭合,仅皮片原位缝合出现7例坏死,经第二次手术创口闭合。63例感染创面经抗炎、植皮和组织瓣方法闭合。结论 伤口闭合方法多,方式选择应遵循由简单到复杂的原则。

Objective To report the experiences of wound closure for open leg fractures.Methods After debridement and routine management,several methods were performed as follows:If tension exists when direct suture was done,relaxation should be taken;If wound overlies soft tissues,skin graft can be considered;Glove torn skin should be restored to thick split skin and be sutured;Delayed primary suture is suitable for serious polluted wound;Fascia skin flap,muscle or skin flap should be used when the wound lying directly over a bone;Diminishing infection is the first step for the infected wound before the closure.Results 128 cases of fresh wounds healed except 7 cases of thick split graft which were healed after second operation.63 cases of infected wound have been closed after anti inflammation,skin graft and tissue flaps.Conclusion There are many methods for wound closure.But the advisable method should be selected according to the size and deepness of the wound,if the simple method has advantage for heal,the multiple is not adopted.