胫骨前肌瓣联合邮票植皮和负压引流术在修复胫骨外露伴软组织缺损创面中的应用

The application of tibialis anterior muscle flap combined with stamp skin grafting and vacuum sealing drainage in the treatment of soft-tissue defect and bone exposure after distal tibia] fracture

目的探讨胫骨前肌瓣联合邮票植皮和负压引流术在修复胫骨外露伴软组织缺损创面中的应用疗效。方法19例胫骨骨折伴有软组织缺损合并骨外露患者，予行胫骨前肌瓣转移修复，封闭式负压引流，创面二期行自体刃厚邮票植皮、负压引流术。结果术后18例肌瓣及创面肉芽生长良好，经刃厚邮票植皮后愈合。1例肌瓣远端出现坏死，经清创换药后，创面二期愈合。所有患者愈合时间10～28d，平均19．5d，随访1～24个月（平均12．5个月），皮片色泽、质地、弹性良好，骨折均愈合。结论胫骨前肌瓣联合自体刃厚邮票植皮和负压引流术，适用于胫骨骨折伴胫骨外露伴软组织缺损创面的修复。

Objective To investigate the application effect of tibialis anterior muscle flap combined with stamp skin grafting and vacuum sealing drainage in the treatment of soft-tissue defect and bone exposure after distal tibial fracture. Method 19 cases of soft-tissue defect and bone exposure after distal tibial fracture underwent tibialis anterior muscle flap transfer and vacuum sealing drainage in the first phase, stamp autologous split-thickness skin grafting and vacuum sealing drainage in the second phase. Results Muscle flap and wound granulation grow well in 18 cases after surgery, healed after stamp split-thickness skin grafting. There was 1 case of distal muscle flap necrosis, whose wound healed in the second phase after debridement dressing. Healing time of all patients varied from 10 d to 28 d, with the average of 19.5 d. Follow-up was 1 to 24 months, with the average of 12.5 months. Color, texture, flexibility of skin graft were good, with all fractures healed. Conclusion Tibialis anterior muscle flap combined with stamp split-thickness skin grafting and vacuum sealing drainage is applicable to soft-tissue defect and bone exposure after distal tibial fracture.