足踝部GustiloⅢ°开放性骨折软组织缺损的显微外科治疗

Microsurgical Treatment of Gustilo Ⅲ° Open Fracture of Feet and Ankle with Soft Tissue Defects

目的：探讨足踝部GustiloⅢ°开放性骨折软组织缺损显微外科的治疗效果。方法：2006年8月至2010年7月收治足踝部Gustilom。开放性骨折并软组织缺损41例，其中ⅢA型18例、ⅢB型15例、ⅢC型8例；软组织缺损面积3．5cm×3．0cm-25．0cm×15．0cm，平均12．0cm×8．0cm；合并软组织感染11例，骨感染4例。均采用显微外科技术行清创和多种皮瓣移植修复术，其中小腿皮神经营养血管逆行岛状皮瓣14例，足底内侧动脉皮瓣4例，游离皮瓣移植23例。结果：本组41例，26例骨折固定的同时行一期创面皮瓣移植修复，15例先行骨折固定、软组织创面经数次清创二期行皮瓣移植修复。术后3例腓肠神经营养血管皮瓣移植失败，后经游离皮瓣手术完成创面覆盖，其余皮瓣全部成活。创面一期愈合39例，二期愈合2例。术后41例均随访3—24月，根据下肢肢体功能评定标准评定疗效，优16例、良19例、可4例、差2例，优良率为85％。结论：足踝部GustiloⅢ°开放性骨折患者的软组织缺损经清创、皮瓣移植修复可获得满意的疗效。

Objective：To investigate the effect of microsurgical treatment in Gustilo HI open fracture of feet and ankle together with the soft tissue defects. Methods ：41 cases with Gustilo HI open fracture of feet and ankle as well ash the soft tissue defects were treated from August 2006 to July 2010 . Gustilom A type were 12 cases, Gustilo ]lib were 11 cases and Gustilom C were 8 cases. The defect areas of soft tissue were from 3. 5 cm x 3.0 cm to 25.0 cm x15.0 cm, the average defect area was 12.0 cm x 8.0 cm . Of which 11 cases had soft tissue infections, bone infections in 4 cases. We debrided the wounds with microsurgery technique and re- paired it with many kinds flaps. After debridement and internal fixation of wounds of 41 cases, neurovascular island flap were applied in 14 cases, 4 cases of medial plantar artery flap and free skin flap in 23 cases. Resuits：26 of 41cases repaired with flaps immediately after the surface of wounds were debrided, fractures of 15 cases were fixed firstly, and the wounds were repaired with flaps secondly when they were debrided thoroughly, failure of 3 cases after neurovascular flap free flap surgery of 41 cases and were performed surgery again with skin flaps in covering the wound, the other flaps survived, wound healed in 39 cases, 2 cases of the second phase after 6 weeks to heal. 41 patients were followed up after 3 months to 2 years, the results were satisfactory, according to lower extremity limb function and other indicators, 16 cases achieved excellent result, 19 cases gained good result, 4 cases were fair and 2 were poor. Excellent and good results were 85%. Conclusions： Gustilo mopen fracture of feet and ankle treated by debridement and repair with flap can get satisfying results.