胫后动脉穿支带蒂皮瓣联合膜诱导技术治疗小腿中下段严重开放性损伤

Treatment of severe open injury of middle and lower leg combined with skin and tibial defects with pedicled skin flap of perforating branch of posterior tibial artery

目的 探讨采用胫后动脉穿支带蒂皮瓣联合膜诱导技术对小腿中下段严重开放性损伤合并皮肤和胫骨缺损治疗的临床效果。方法 选取2017年10月-2020年12月收治的40例由于创伤导致小腿中下段严重开放性损伤合并皮肤及胫骨缺损的患者,利用胫后动脉穿支带蒂皮瓣联合膜诱导技术分三个阶段进行治疗。结果 对患者进行6~24个月随访,所有皮瓣全部成活且胫骨愈合良好,有2例出现皮瓣远端部分坏死,但其皮下有肉芽生长,经换药愈合;有1例发生移植骨骨折,经石膏固定后达到骨愈合,患肢外观、功能恢复满意。结论 针对小腿中下段开放性损伤合并皮肤及骨缺损的患者,采用胫后动脉穿支带蒂皮瓣联合膜诱导技术进行治疗是一种有效的方法,具有操作灵活简单、治疗周期短、骨折愈合快、学习曲线短等优势,值得推广。

Objective To investigate the specific efficacy of posterior tibial artery perforator pedicled skin flap combined with membrane induction on the treatment of severe open injury of middle and lower leg combined with skin and tibial defects. Methods Fourty patients with severe tibial artery injury were treated by three stages of tibial flap puncture. Results The patients were followed up for 6 ~24 months. All flaps survived and the tibia healed well. There were 2 cases of partial necrosis of the distal part of the flap, but there was granulation growth under the skin, which healed after dressing change;One patient had bone graft fracture, which achieved bone healing after plaster fixation. The appearance and function of the injured limb were satisfactory. Conclusion For patients with open injury of the middle and lower leg combined with skin and bone defects, the technique of pedicled skin flap of perforating branch of posterior tibial artery combined with membrane induction is an effective method. It has the advantages of flexible and simple operation, short treatment cycle, fast fracture healing and short learning curve, which is worthy of popularization.