VSD联合腓肠神经营养血管皮瓣修复术治疗小腿GustiloⅢ型骨折软组织缺损的临床疗效

Clinical effects of VSD combined with sural neurovascular flap prosthetics in repairing soft tissue defects of Gustilo type-Ⅲfractures

目的:探讨应用负压封闭引流(vacuum sealing drainage,VSD)技术联合腓肠神经营养血管皮瓣修复术治疗小腿GustiloⅢ型骨折的临床疗效。方法:选取2012-05~2019-09收治的小腿GustiloⅢ型骨折软组织缺损患者17例,车祸碾压伤13例,机器挤压、绞伤4例,其中GustiloⅢB型8例,GustiloⅢC型9例,均合并骨质外露及不同程度污染,均Ⅰ期行清创术+VSD,择期根据创面恢复情况行腓肠神经营养皮瓣修复术修补缺损创面,术后观察治疗效果。结果:17例患者术后随访10~21个月(平均13.4个月),皮瓣全部成活,外形美观,无迟发感染等并发症发生。14例经外固定架固定后骨折愈合时间为10~13个月(平均11.3个月),3例发生骨折不愈合,分别于术后7~8个月行植骨、髓内钉内固定术后愈合。结论:VSD联合腓肠神经营养血管皮瓣治疗小腿GustiloⅢ型骨折软组织缺损,可减轻患者痛苦,减少医疗工作量,降低感染率和提高皮瓣成活率,是一种理想的小腿软组织修复方法。

Objective:To explore clinical effects of vacuum sealing drainage(VSD)combined with sural neurovascular flap prosthetics in the treatment of soft tissue defects of Gustilo type-Ⅲfractures.Methods:Seventeen cases with soft tissue defects of Gustilo type-Ⅲfractures admitted to our hospital between May 2012 and September 2019 were selected,including 13 cases of crush injuries and 4 cases of machine extrusion and wringing injury,8 cases of Gustilo type-ⅢB and 9 cases of Gustilo type-ⅢC.All patients were associated with bone exposure and different degrees contamination.All of them were treated with debridement and VSD for the wounds at the primary stage,and wounds coverage with sural neurovascular flap prosthetics at the secondary stage.Postoperative efficacy was observed.Results:Seventeen patients were followed up for 10-21 months(with average of 13.4 months),and found that all the flaps survived without ulcer and effusion,14 fractures were cured from 10 to 13 months(with average of 11.3 months)after operation,nonunion occurred in 3 cases which were healed by bone grafting at 7-8 months respectively after operation and no delayed wound infection.Conclusion:VSD combined with sural neurovascular flap prosthetics in the teratment of soft tissue defects of Gustilo type-Ⅲfractures can effectively relieve the pain,reduce medical workload and wound infection,and improve flap survival rate,which is an ideal soft tissue repair method.