急诊游离髂骨骨皮瓣一期修复下肢骨皮肤缺损

Repairing the bone skin defect on legs with free cutaneous iliac flap in emergency treatment in the first period

目的探讨急诊游离髂骨骨皮瓣一期修复下肢骨皮肤缺损的优点和可行性，并总结其疗效。方法对6例不同损伤原因造成的下肢部分骨质缺损，伴有不同程度的皮肤损伤，采用急诊游离髂骨骨皮瓣一期修复。皮肤缺损面积5．0cm×6．0cm×7．0cm×12．0cm，骨质缺损3．0cm×5．0cm×4．5cm×5．5cm，皮瓣面积6．0cm×9．0cm-7．0cm×14．0cm，骨质切取面积3．0cm×6．0cm-5．0cm×6．0cm．皮瓣供区全部直接缝合。结果移植骨皮瓣全部成活，术后伤口一期愈合。随访2～16个月（平均10个月）．所有病例骨折均愈合，临床愈合时间6-8周，骨性愈合时间7-10个月。移植骨均未见吸收，未见骨不连及再骨折。移植皮瓣外形良好，二次修薄2例。皮瓣无色素沉着和增生性瘢痕。下肢行走良好。供区一期愈合。结论急诊游离髂骨骨皮瓣修复下肢骨皮肤缺损，一期修复骨质和皮肤缺损，减少住院天数和住院费用，骨愈合快，获得精细的专科修复。

Objective To research the advantages and feasibility of using the free cutaneous iliac flap to repair the defect on legs in emergency treatment in the first period, and summarizing its effect. Methods For 5 patients of leg injury caused by different reasons, using the free cutaneous iliac flap to repair the defect on legs in emergency treatment in the first period. The injury mainly led to partial bone defect on legs, with cutaneous injury in varied degree. It was estimated that cutaneous necrosis will happen after surgery and scar will be left after debridement. The area of skin defect was about 5 cm×6 cm-7 cm×12 cm. Bone defect was about 3.0 cm×5.0 cm×4.5 cm×5.5 cm, and the area of flap was about 6 cm×9 cm-7 cmXl4 cm. bone cutting area was about 3.0 cm×6.0 cm-5.0 cm×6.0 cm, cutaneous graft was sutured directly. Results Transplanted iliac flap all survived, the wound healed in the first period after the surgery. Following up 2~ 16 months （10 months on average）, fractures of all cases healed. Clinical healing time was 6~8 weeks. The bone graft healed with the host bone in 7~I0 months on average. The bone graft was not seen to be absorbed. No nonunion and re-fracture was seen. Transplanted flap was in good shape. There were 2 cases of second-thining. There was no pigementation and hyperplastic scar. Patients walked well with their legs. Donor site healed in the first period. Conclusion Using free cutaneous iliac flap to repair the defect of the legs in emergency treatment, bone and cutaneous defect healed in the first period, decreasing the time of patients in hospital. Bone heals fast, getting fine special repairing.