组织瓣移植联合骨延长技术分期修复烧创伤后下肢严重软组织与骨缺损

Tissue flap combined with sequential bone lengthening technique for repairing severe soft tissue and bone defects of lower extremity after burn injury

目的探讨组织瓣移植联合骨延长技术修复烧创伤后下肢严重软组织与骨缺损的临床效果。方法2010年1月—2015年12月,收治严重股骨或胫骨合并皮肤软组织缺损患者11例。男10例,女1例;年龄19~37岁,平均28岁。致伤原因:交通事故伤8例,高压电烧伤2例,CO中毒烧伤1例。伤后至该次入院时间为3~14 d,平均6.5 d。骨缺损长度8~18 cm,平均14 cm;皮肤软组织缺损范围13 cm×8 cm^25 cm×19 cm。一期彻底去除坏死组织和病变股骨或胫骨断端,组织瓣修复软组织缺损;二期采用Orthofix单边外固定延长架或Ilizarov环形外固定延长架修复骨缺损。结果术后1例修复术后2个月皮瓣下出现一窦道,经扩创、去除坏死股骨、抗生素骨水泥间隔物填充后愈合;其余患者切口均Ⅰ期愈合。骨延长期间,1例出现针道感染,经换药和加强护理后控制感染。患者截骨段延长8~18 cm,平均14 cm;停止延长后外固定支架继续保留4~12个月,平均6.5个月。患者骨缺损均修复,骨愈合时间为12~22个月,平均17个月。患者均获随访,随访时间8~24个月,平均15个月。患者治疗期间均未出现血管、神经损伤,术后未见骨髓炎、再骨折等并发症发生,下肢功能恢复较好。结论组织瓣移植联合骨延长技术修复烧创伤后下肢严重软组织与骨缺损可获较好疗效。

Objective To investigate the effectiveness of tissue flap grafting and sequential bone lengthening for repairing severe soft tissue and bone defects of the lower extremity after burn injury. Methods Between January 2010 and December 2015, 11 cases of large segmental bone and soft tissue defects in the leg were treated. There were 10 males and 1 female, with a mean age of 28 years （range, 19-37 years）. The causes included traffic accident in 8 cases, high voltage electric burn in 2 cases, CO poisoning burn in 1 case. The time from injury to admission was 3-14 days （mean, 6.5 days）. The bone defect length was 8-18 cm （mean,14 cm）; the skin soft tissue defect ranged from 13 cm × 8 cm to 25 cm × 19 cm. After complete removal of necrotic tissue and lesions of the femur or the tibia, the tissue flaps were used to repair soft tissue defect of the lower extremity in one-stage operation; bone defect was treated by Orthofix single side external fixation or Ilizarov ring external fixation in two-stage operation. Results Eleven faps survived completely, primary healing of incision was obtained in the others except for 1 patient who had necrotic bone infection, which was cured after removing necrosed femoral bone and filling with antibiotic bone cement spacer. During bone lengthening, pin tract infection occurred in 1 patient, and infection was controlled after dressing change. Bone lengthening ranged from 8 to 18 cm, with an average of 14 cm. After prolonged extension, the external fixator was retained for 4-12 months （mean, 6.5 months）. All bone defects were repaired with bone healing time of 12-22 months （mean, 17 months）. All patients were followed up 8-24 months （mean, 15 months）. No vascular and neurological complication occurred during operation; no osteomyelitis or re-fracture occurred after operation, and the recovery of the lower extremity function was good. Conclusion Tissue flap grafting combined with bone lengthening is an effective method to repair severe bone and soft tissue defects of lower extremity