同期联合应用游离组织瓣移植和封闭负压引流治疗四肢骨感染骨外露

Clinical study of free tissue flap firstly associated with VSD to treat bone exposure with infection on limbs

目的介绍同期联合应用吻合血管的游离组织瓣和封闭负压引流(USD)治疗四肢骨外露并感染病例的临床治疗经验方法 2009年5月~2012年1月,应用游离股前外侧肌皮瓣联合VSD治疗并发感染的骨外露27例,其中胫骨上段5例,胫骨中下段20例,前臂尺桡骨骨外露2例。男16例,女11例。年龄23~67岁,平均40.5岁。方法首先进行创面清创,按创面需求切取肌皮瓣并进行吻合血管游离移植,组织瓣不需完全覆盖创面,需遗留1~2处通道与深部创腔相通,放置VSD进行封闭引流,可以同时进行冲洗。结果组织瓣移植全部成活,成活率达100%,皮缘部分坏死1例。肢体创面修复时间提前2周,术后3周闭合创面16例,5周闭合创面8例,经长期换药治疗,内固定取出术后愈合3例。术后随访6~15月,1例改内固定患者于术后2个月发生感染,经切开引流后完全愈合,随访8个月未再发感染。结论游离组织移植结合VSD技术一期修复创面是安全可行的,可以缩短治疗周期,避免围手术期创面感染,但对广泛组织坏死的创面不能达到一期闭合的目的 ,仍需反复彻底的创腔清创。

Objective To share clinical therapy experience of using free tissue flap firstly associated with VSD to treat bone exposure with infection on limbs. Methods From May 2009 to January 2012, twenty-seven patients with bone exposure and infection were applied to anterolateral thigh flap grafting associated with VSD. There were 16 males and 11 females, with an average age of 40.5 years （range from 23 to 67 years）. 5 patients＇ wound were on superior tibia, 20 on the middle-inferior segment of tibia, and 2 patients had ulna-radial bone exlx^ure. Surgical method： wound debridement firstly, free musculocutaneous flaps with vascular anastomosis were grafted to cover wound, the wound weren＇t completely covered by flaps, but left with 1 to 2 thoroughfare communicated with deep bone wound. Results All tissue flaps survived, 1 patient＇s flap edge happened part necrosis. The time of the wound repairation was 2 weeks earher.16 patients＇ wound were closed after 3 weeks of operation, 8 were closed after 5 weeks of operation, and through long-term dressing changing, 3 healed after taking out of internal fixation. All patients were followed up from 6 to 15 months, l patient who changed to internal fixation happened infection after 2 months of operation, the wound completely healed through incision and drainage, it was followed up 8 months and didn＇t happened infection again. Conclusion It is demonstrated that it is safe that incision and drainage to using free tissue flap firstly associated with VSD to treat wound, it can decurtate treatment cycle and avoid early infection, but the wound with general tissue necrosis can＇t be primary closure, and it need to debride repeatedly and thoroughly.