股前外侧Flow-through皮瓣联合Masquelet技术在胫骨远端Gustilo ⅢC型骨折急诊保肢中的应用

Anterolateral thigh Flow-through flap transfer combined with Masquelet technique:in emergency surgery of limb salvage for Gustilo IIIC distal tibial fractures

目的探讨急诊股前外侧Flow-through皮瓣移植联合Masquelet技术治疗合并软组织缺损的胫骨远端GustiloⅢC型骨折的临床疗效。方法2017年7月至2021年5月,无锡市第九人民医院骨科采用急诊股前外侧Flow-through皮瓣移植联合Masquelet技术治疗胫骨远端GustiloⅢC型骨折合并软组织缺损患者7例,男5例,女2例;年龄36~63(50.0±10.4)岁。软组织缺损面积11 cm×4 cm~23 cm×7 cm,骨缺损长度3.5~7.5(5.34±1.52)cm,血管缺损长度7~12(9.21±2.34)cm,皮瓣切取面积12 cm×5 cm~24 cm×8 cm。所有患者均获得门诊随访,随访内容包括伤口并发症、植骨部位愈合情况以及肢体功能恢复。结果所有7例患者皮瓣均成活,保肢成功,患者小腿伤口无感染,植骨部位均骨性愈合。术后随访12~38(26.29±10.73)个月。末次随访时,患肢外形及功能恢复较满意;踝关节功能依据美国足踝关节协会(AOFAS)评分:优3例,良3例,可1例。结论股前外侧Flow-through皮瓣移植联合Masquelet技术治疗胫骨远端GustiloⅢC型开放骨折,一期闭合创面、重建远端肢体血供,二期植骨内固定,急诊保肢成功率高,患肢功能恢复良好,是一个安全有效、切实可行的方案。

ObjectiveTo investigate the therapeutic effect of anterolateral thigh Flow-through flap transfer surgery combined with Masquelet technique in reconstruction of Gustilo IIIC open fractures of distal tibia.MethodsBetween July 2017 and May 2021,7 patients who had Gustilo IIIC injuries in the lower limb were treated in the Department of Orthopaedics Surgery,Wuxi 9th People's Hospital by emergency surgery with transfer of anterolateral thigh Flow-through flap combined with Masquelet technique.The patients were 5 males and 2 females,aged 36 to 63(50.0±10.4)years old.Size of soft tissue defects was 11 cm×4 cm to 23 cm×7 cm,the length of bone defects was 3.5-7.5(5.34±1.52)cm and the bridging length for vascular defects was 7-12(9.21±2.34)cm.The size of the flaps was 12 cm×5 cm-24 cm×8 cm.All patients received postoperative follow-up at the outpatient clinic and complications of wound,fracture healing and the recovery of limb function were observed.ResultsAll flaps survived uneventfully and successful limb salvage were achieved in all 7 patients,together with all bone grafts healed without infection.The follow-up lasted for 12-38(26.69±10.73)months.At the last follow-up,the appearance and functional recovery of the lower limbs were satisfactorily.The function of ankle was evaluated according to American Orthopedic Foot and Ankle Society(AOFAS):3 patients in excellent,3 in good and 1 in fair.ConclusionEmergency anterolateral thigh Flow-through flap transfer surgery with Masquelet technique is a safe,effective and feasible surgical procedure for Gustilo IIIC open fractures of distal tibia.It allows to close the wound and rebuild the blood supply in distal limb in the primary or emergency surgery,and allows to perform bone grafting and internal fixation in stage-II surgery.The patients benefit from high rate of success in limb salvage and good function recovery of the affected limb.