远端蒂隐神经营养血管皮瓣联合封闭负压吸引技术在胫骨远端钢板外露中的临床应用

Clinical application of the reversed saphenous fasciocutaneous island flap combined with the vacuum sealing drainage therapy in plate exposure of the distal tibia

目的探讨远端蒂隐神经营养血管皮瓣联合封闭负压吸引技术在胫骨远端钢板外露中的临床应用效果。方法2008年1月至2010年7月，对7例7侧胫骨远端骨折术后出现皮肤软组织缺损合并钢板外露的患者采用远端蒂隐神经营养血管皮瓣联合封闭负压吸引技术进行治疗。患者于钢板外露后7—26d接受封闭负压吸引。术后7～14d．创面行远端蒂隐神经营养血管皮瓣覆盖。创面缺损面积4cm×2cm-13cm×4cm。结果创面封闭负压吸引平均1．3次。经负压吸引后，创面肉芽组织生长良好。所有创面均行远端蒂皮神经营养血管皮瓣覆盖，皮瓣面积6cm×3cm-15cm×6cm。其中6例患者，术后皮瓣完全成活，1例出现皮瓣远端边缘部分坏死。术后4—6个月，x线证实骨折愈合。所有皮瓣与受区愈合良好，无骨髓炎及慢性窦道形成等并发症。结论远端蒂隐神经营养血管皮瓣联合封闭负压吸引技术在治疗胫骨远端钢板外露中能达到保留钢板、覆盖创面的目的。

Objective To evaluate the clinical effect of the reversed saphenous fasciocutaneous is- land flap combined with the VSD therapy in plate exposure of the distal tibia. Methods From January 2008 to July 2010, seven patients with hardware exposure following internal fixation of the distal tibia frac- ture were treated by VSD therapy and reversed saphenous fascioeutaneous island flap reconstruction. The VSD therapy was performed from 7 to 26 days after hardware exposure, and the flap transfer was performed 7 to 14 days after the VSD therapy. The size of the soft - tissue defect ranged from 4 cm ×2 cm to 13 cm × 4 cm. The mean follow-up was 10.6 months after the fracture （range, 8-14 months）. Results The average times of the VSD therapy was 1.3. After VSD was removed, the exposed hardware was covered by healthy granulation tissue in all cases. All flaps were successfully transplanted, and the size of flap ranged from 6 cm× 3 cm to 15 cm × 6 cm. Six of 7 flaps survived completely without further procedures. The necrosis of the distal margin of the flap occurred in 1 patient. A solid bony union was confirmed by the X - ray in all pa- tients after 4-6 months postoperatively. No skin defects or fistulae were observed. Conclusion The combi- nation of the reversed saphenous faseiocutaneous island flap and VSD therapy could save the exposed hard- ware and cover the soft tissue defects in the distal tibia.