股前外侧肌皮瓣序贯髂骨瓣移植修复治疗胫骨骨缺损合并软组织缺损

Efficay of anterolateral thigh myocutaneous flap combined with iliac bone flap for treatment of tibia bone defect with soft tissue defect

目的观察采用股前外侧肌皮瓣序贯髂骨瓣移植修复治疗胫骨骨缺损合并软组织缺损的临床疗效。方法回顾性分析自2018-01—2021-08因GustiloⅢB、ⅢC型开放性胫骨骨折导致的11例胫骨骨缺损合并软组织缺损,一期手术应用股前外侧肌皮瓣修复软组织缺损创面,一期手术4个月后应用带旋髂深血管髂骨瓣修复骨缺损。观察肌皮瓣成活情况、伤口愈合情况、髂骨瓣愈合时间以及并发症发生情况,末次随访时根据Johner-Wruhs评价标准评估手术疗效。结果11例均获得随访,随访时间6~27个月,平均10.6个月。皮瓣全部成活,未出现皮瓣血管危象。1例皮瓣修复术后伤口延迟愈合,换药3周后愈合,其余患者伤口均一期愈合。髂骨瓣移植术后2周切口均顺利愈合,无感染迹象。11例骨折端均获得骨性愈合,骨愈合时间为4~7个月,平均5.4个月。所有患者均未出现钢板螺钉松动断裂、移植髂骨骨质硬化及吸收现象。末次随访时Johner-Wruhs功能评定结果:优6例,良4例,可1例。所有患者的患肢小腿外形、功能恢复满意。结论对于胫骨骨缺损合并软组织缺损患者,采用股前外侧肌皮瓣序贯髂骨瓣移植能有效修复软组织缺损,促进骨缺损处顺利愈合,同时减少并发症的发生。

ObjectiveTo observe the clinical effect of combined application of anterolateral thigh myocutaneous flap and iliac bone flap to repair tibia bone defect with soft tissue defect.MethodsA retrospective analysis was conducted on 11 patients with tibial bone defects and soft tissue defects caused by GustiloⅢB andⅢC open tibial fractures from January 2018 to August2021.The anterolateral thigh muscle flap was used to repair the soft tissue defect wound in the first stage,and the iliac bone flap with deep iliac circumflex vessel was used to repair the bone defect 4 months later.The survival of musculocutaneous flap,wound healing,iliac bone flap healing time and the occurrence of complications were observed.The surgical effect was evaluated according to Johner-Wruhs functional evaluation criteria in the last follow-up.ResultsAll patients were followed up for 6to 27 months,with an average of 10.6 months.All the flaps survived without vascular crisis.The wound of one patient was delayed healing after skin flap repair.The wound healed 3 weeks after dressing change.The wound of the other patients was healed in the first stage.The incisions of iliac bone flap healed smoothly 2 weeks after operation,and there was no sign of infection.All 11 patients had bone healing,the healing time was 4 to 7 months,with an average of 5.4 months.No plate and screw loosening and breakage occured,no osteosclerosis and resorption of the grafted iliac bone were observed in all the patients.In the last follow-up,according to Johner-Wruhs functional evaluation criteria:excellent in 6 cases,good in 4 cases,and fair in 1case.The appearance and function of the affected limb recovered satisfactorily.ConclusionFor patients with tibia bone defect and soft tissue defect,anterolateral thigh myocutaneous flap combined with iliac bone flap can effectively repair the soft tissue defect,promote the smooth healing of bone defect,and effectively control the occurrence of complications.