应用负压吸引技术联合自体组织瓣移植修复胫骨骨折术后钢板外露

Application of Negative Pressure Wound Therapy Combined With Autologous Tissue Flap Transplantation to Repair Steel Plate Exposure After Tibial Fracture Surgery

目的 探讨封闭式负压吸引技术联合自体组织瓣移植在修复胫骨骨折术后钢板外露的临床效果。方法 回顾性分析2019年6月至2021年5月收治的18例胫骨骨折术后钢板外露患者的临床资料,男性13人、女性5人,平均年龄47岁。在创面彻底清创后,应用封闭式负压吸引技术控制创面感染、改善创面条件。待创面准备充分、达移植条件后,选择合适的皮瓣、肌皮瓣或肌瓣,可联合皮片移植,修复胫前创面。术后继续配合封闭式负压吸引。结果 本组病例中,15例患者创面甲级愈合,3例患者术后再次出现钢板外露。其中,1例为原部位再次外露,2例为其他胫前部位出现新创面,创面面积均较小,再次进行清创、自体组织瓣移植联合封闭式负压吸引治疗后,取得良好修复效果。结论 对于胫骨骨折术后内固定钢板外露的患者,封闭式负压吸引技术联合自体组织移植能尽可能地保留内固定物,快速、有效地控制局部炎症感染,尽早修复创面,有良好的临床疗效。

Objectivs To discuss the clinical effect of the combination of negative pressure wound therapy(NPWT)and autologous tissue flap transplantation in repairing the exposure of steel plate after tibial fracture surgery.Methods The clinical data of 18 patients with steel plate exposure after tibial fracture surgery who were received and treated from June 2019 to May 2021 were retrospectively analyzed,including 13 men and 5 women.The average age was 47.After thorough debridement of the wound,the NPWT was used to control infection and improve the conditions of the wound.After the wound was fully prepared and met the transplantation conditions,a suitable flap,musculocutaneous flap,or muscle flap was selected.The skin transplantation could be combined to repair the anterior tibial wound.After surgery,NPWT was cooperated with.Results In this group of cases,the wound healing of 15 patients was Grade A and 3 patients had exposure of steel plate again after surgery.Among them,1 case was another exposure at the original site and 2 cases were new wounds at other anterior tibial sites.The wound was relatively small.After another debridement and the combination of autologous tissue flap transplantation and NPWT,good repairing results were obtained.Conclusion For patients with exposure of internal fixation steel plates after surgery of the fracture of tibia,the combination of NPWT and autologous tissue transplantation can retain internal fixations as much as possible,control local inflammation and infection fast and effectively,repair the wound as soon as possible,and have a good clinical effect.