游离股前外侧穿支皮瓣联合外固定支架在小腿GustiloⅢ型骨折中的临床应用

Clinical application free anterolateral thigh perforator flap combined with external fixation stent in calf Gustilo typeⅢfracture

目的探讨游离股前外侧穿支皮瓣联合外固定支架在小腿GustiloⅢ型骨折中的临床应用效果。方法回顾性分析2015年1月—2018年1月四川宜宾中康骨科医院骨科应用游离ALTP联合外固定支架治疗小腿GustiloⅢC型骨折患者25例,男性19例,女性6例;年龄18~59岁,平均42.5岁。致伤原因:道路交通伤10例,机械伤15例。均有明确的骨折和血管、神经、肌肉以及皮肤软组织损伤,均属于GustiloⅢC型。小腿创面缺损范围7.5cm×8.5cm^25.0cm×13.0cm。Ⅰ期急诊下行清创探查术,修复重要的血管、神经、肌腱,骨折予以外支架固定。待创面清洁时,Ⅱ期行游离ALTP修复创面。术后均予以抗感染、抗血栓、抗血管痉挛等治疗,皮瓣成活后根据下肢力线及骨愈合情况更改内固定术。结果22例游离皮瓣顺利成活,3例因皮瓣切取面积较大,远端少许坏死,经换药、植皮等处理后创面愈合。皮瓣成活后17例患者拆除外固定支架更改内固定,8例患者外固定支架成为终极的固定方式。25例均获随访,随访时间10~18个月,平均12.4个月。骨折端对位良好,力线恢复,骨愈合正常。结论游离皮瓣联合外固定支架治疗小腿GustiloⅢ型骨折可有效修复创面,促进骨愈合,临床效果好。

Objective To explore the clinical application of free anterolateral thigh perforator flap combined with external fixation stent in calf Gustilo type Ⅲ fractures. Methods From Jan. 2015 to Jan. 2018,25 patients with calf Gustilo ⅢC fractures were treated with anterolateral thigh perforator flap combined with external fixators. There were 19 males and 6 females,with an average age of 42. 5 years( 18-59 years). Causes of injury: road traffic injury in 10 cases,mechanical injury in 15 cases. All of them were Gustilo Ⅲ C type fractures. Calf soft tissue defects ranged from 7. 5 cm × 8. 5 cm to 25. 0 cm × 13. 0 cm. Debridement and exploratory surgery was performed in the first-stage to repair important blood vessels,nerves,and tendons. Fractures were fixed with external stents.When the wound were clean,the second stage of free ALTP was applied to repair the wound. All patients were treated with anti-infection,anti-thrombosis,anti-vasospasm,etc. After the flap survived,the internal fixation was changed according to the lower limb force line and bone healing. Results All 22 cases of free flap survived successfully,of which 3 cases had large area of skin flaps and a little necrosis at the distal end. The wounds healed after treatments such as dressing change and skin grafting. After the flap survived,17 patients removed the external fixation stent to change the internal fixation,and 8 patients used stent for the ultimate fixation. Twenty-five patients were followed up for 10 to 18 months,with an average follow-up of 12. 4 months. The fracture ends were well aligned,the line of force recovered,and bone healing was normal. Conclusion Free skin flap combined with external fixation stent has the advantages of effectively repairing wounds and promoting bone healing. It can achieve good clinical results in the clinical application of treating calf Gustilo type Ⅲ fractures.