胫后动脉穿支皮瓣治疗Pilon骨折术后前内侧切口愈合不良

The anterior medial incision poor healing after Pilon fracture treated by tibial artery perforator flap

目的探讨利用胫后动脉穿支皮瓣一期修复Pilon骨折术后前内侧切口愈合不良的临床疗效。方法2012年6月至2015年8月，对13例13侧Pilon骨折术后出现前内侧切口愈合不良并出现肌腱或者钢板外露且无急性感染的患者，在彻底清创后利用胫后动脉穿支皮瓣一期修复创面。结果所有创面在彻底扩创后一期行胫后动脉穿支皮瓣修复，其中12例患者术后皮瓣完全成活，1例出现皮瓣远端1/3面积皮肤坏死，予以行清创、游离植皮术后愈合良好。随访所有患者5~14个月，平均9.8个月，皮瓣或植皮均成活良好，无软组织感染及骨髓炎等并发症，踝关节功能恢复基本正常。结论在彻底清创的基础上，利用胫后动脉穿支皮瓣一期修复无急性感染的Pilon骨折术后前内侧切口愈合不良创面，是一种简单有效的方法，值得在临床上推广。

Objective To investigate the clinical efficiency of applying tibial artery perforator flap to treat anterior medial incision poor healing one-stage after Pilon fracture. Methods Front June, 2012 to August, 2015, 13 cases of anterior medial incision poor healing after Pilon fracture, with tendon or plate exposure in patients and without acute infection, treated by tibial artery perforator flap to repair wound one-stage after thorough debridement. Results All the wounds were repaired by tibial artery perforator flap after a thorough debridement. There was flap necrosis in distal 1/3 part of flap in 1 case, which gained healing after debridement and skingrafting. The remaining 12 cases of flaps survived well. All patients were followed up for 5-14 months （mean 9.8 months）, the flaps or skin grafts survived well, without tissue infection, osteomyelitis and other complication, and the functional recovery of the ankle was basically normal. Conclusion It is a simple and effective method by using posterior tibial artery perforator flap to treat anterior medial incision poor healing one-stage with non-acute infection after Pilon fracture on the basis of thorough debridement, worthy of clinical application and promotion.