小腿骨骼与皮肤复合缺损感染性创面治疗方法的探讨

The investigation of the treatment of infection, complex defect of skin and bone in crus

目的 探讨小腿骨骼与皮肤复合缺损感染性创面治疗的方法。 方法 对 6 8例伴有骨骼与皮肤复合缺损的感染创面 ,在充分抗感染治疗的基础上 ,先进行彻底清创 ,切除感染与坏死的骨骼与皮肤 ,采用血运丰富的皮瓣覆盖全部创面 ,术后继续抗感染治疗 ,使创面愈合 ;在创面感染彻底治愈与皮肤完全正常覆盖的基础上 ,行骨骼缺损的修复 ,用单腓骨移植修复 35例 ,双腓骨移植修复 2 8例。 结果 6 8例移植的皮瓣全部成活 ,伤口覆盖的皮肤正常 ;移植的骨骼经 4～ 5年随访完全愈合 ,无因伤口感染或骨骼与皮肤缺损而截肢。 结论 在感染创面彻底清创的基础上 ,用血运丰富的皮瓣修复皮肤缺损 ,使伤口能正常愈合 ;在感染彻底治愈的基础上 ,行长段骨缺损的修复 ,能保住肢体 ,为功能修复创造条件。

Objective To investigate the effective method of the treatment of the infective, complex defect of skin and bone in crus. Methods On the basis of through anti-infection, the infective surface of wound with bone and skin complex defect was completely debrided. The infective and necrotic skin and bone were moved away, and the wound surface was covered with flaps having abundant circulation. The anti-infection therapy was continued after operation. When the infection healed and the normal skin covered the wound, the bone defect was renovated at the second stage. Result The transplanted flaps all survived and the skin covering the wound remained normal. After the follow-up of four to five years, all the transplanted bones healed completely. No limbs were amputured because of wound infection or the complex defect of bone and skin. Conclusion After the infective surface of wound was completely debrided, the skin defect was renovated with flaps having abundant circulation. On the basis of infection being totally cured, the lone-piece-bone defect was renovated. This method can maintain the limbs and creat conditon for the functional recovery.