术前不同创面准备联合胫后动脉穿支螺旋桨皮瓣技术治疗感染性踝内侧软组织缺损创面的疗效比较

Comparison of the efficacy of different preoperative wound preparations combined with posterior tibial artery perforator propeller flap in the treatment of infected medial malleolus soft tissue defect wounds

目的探讨抗生素骨水泥联合胫后动脉穿支螺旋桨皮瓣技术与负压封闭引流(VSD)联合胫后动脉穿支螺旋桨皮瓣技术治疗感染性踝内侧软组织缺损创面的疗效。方法30例感染性踝内侧软组织缺损患者,按照治疗方法的不同分为A组与B组,每组15例。A组患者采用抗生素骨水泥联合胫后动脉穿支螺旋桨皮瓣技术治疗,B组患者采用VSD联合胫后动脉穿支螺旋桨皮瓣技术治疗。比较两组患者的住院时间、抗生素使用时间,观察两组患者皮瓣成活情况、感染控制情况及并发症发生情况。结果两组患者治疗后皮瓣全部成活,手术时间为90~150 min,平均手术时间为110 min,皮瓣切取面积为7.0 cm×5.0 cm~12.5 cm×6.0 cm。供区植皮或直接缝合,供区愈合良好,术后无1例发生感染,有2例出现皮瓣远端部分表皮坏死,换药后愈合。A组住院时间为(19.26±2.60)d,抗生素使用时间为(17.46±3.04)d;B组住院时间为(26.26±2.80)d,抗生素使用时间为(25.73±3.28)d。A组住院时间、抗生素使用时间短于B组,差异有统计学意义(P<0.05)。结论抗生素骨水泥联合胫后动脉穿支螺旋桨皮瓣技术与VSD联合胫后动脉穿支螺旋桨皮瓣技术治疗感染性踝内侧软组织缺损创面均疗效确切,临床应用过程中需结合患者的身体素质、经济实力及创面情况等因素具体分析而确定采用哪种治疗技术。

Objective To discuss the efficacy of antibiotic-loaded bone cement combined with posterior tibial artery perforator propeller flap and vacuum sealing drainage(VSD)combined with posterior tibial artery perforator propeller flap in the treatment of infected medial malleolus soft tissue defect wounds.Methods A total of 30 patients with infected medial malleolus soft tissue defect wounds were divided into group A and group B according to different treatment method,with 15 patients in each group.Patients in group A were treated with antibiotic-loaded bone cement combined with posterior tibial artery perforator propeller flap,and patients in group B were treated with VSD combined with posterior tibial artery perforator propeller flap.The hospitalization time and antibiotic use time of the two groups were compared,and the flap survival,infection control and occurrence of complications of the two groups were observed.Results After treatment,all the flaps survived in both groups.The operation time was 90-150 min,with an average of 110 min,and the area of the flaps was 7.0 cm×5.0 cm-12.5 cm×6.0 cm.Skin grafting or direct suture in the donor area resulted in good healing.No infection occurred after surgery,and partial epidermal necrosis occurred in the distal part of the flap in 2 cases,which healed after dressing change.The hospitalization time of group A was(19.26±2.60)d,and the antibiotic use time was(17.46±3.04)d;the hospitalization time of group B was(26.26±2.80)d,and the antibiotic use time was(25.73±3.28)d.The hospitalization time and antibiotic use time in group A were shorter than those in group B,and the difference was statistically significant(P<0.05).Conclusion Both antibiotic-loaded bone cement combined with posterior tibial artery perforator propeller flap and VSD combined with posterior tibial artery perforator propeller flap are effective in treating infected medial malleolus soft tissue defect wounds.In the clinical application,it is necessary to determine which treatment technique to use by taking into account the patient’s physical quality,economic strength and wound condition.