利用不同类型交腿皮瓣治疗合并严重软组织缺损的小腿骨外露  

Treatment of Lower-Limb Bone Exposure Combined with Severe Soft Tissue Defect Using Different Kinds of Cross-Leg Flaps

作　　者：祝少博[1] 喻爱喜[1] 余国荣[1] 蔡林[1] 

机构地区：[1]武汉大学中南医院骨科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2009年第5期697-700,共4页Medical Journal of Wuhan University

摘　　要：目的:评估不同类型交腿皮瓣治疗合并严重软组织缺损小腿骨外露的临床疗效。方法:35例合并有严重软组织缺损的小腿骨外露患者,常规对骨外露创面行清创并行封闭式负压引流,待骨外露创面无明显炎症,二期再根据创面的大小及性状选择传统皮瓣交腿、皮神经营养血管皮瓣交腿、主干血管为蒂的轴型皮瓣交腿及桥式交叉皮瓣交腿覆盖创面及修复组织缺损,并用组合式外固定架固定患侧肢体的骨折,将健侧肢体与患侧肢体固定于合适的位置,术后4-5周行桥式皮瓣或交腿皮瓣断蒂术。结果:35例患者小腿骨外露均得到良好的覆盖,皮瓣无1例坏死,2例患者因局部感染太重,创面覆盖后因慢性骨髓炎形成窦道,1例经搔扒及抗感染治疗于术后6月窦道愈合,1例窦道术后近1年仍迁延不愈。结论:对合并有严重软组织缺损的小腿骨外露,根据创面的情况选用合适类型的交腿皮瓣,可以取得良好的临床疗效。Objective： To evaluate the efficacy of different kinds of cross-leg flaps in treating bone exposure of the lower leg combined with severe soft tissue defect.Methods： Thirty-five cases were presented in the study.All the patients were open and splintered tibiofibular fracture combined with main vessel injury and severe soft tissue trauma.The wound surface was conventionally debrided and vacuum sealing drainage（VSD） was used.When there was no obvious inflammation at the wound surface of bone exposure,according to the size and trait of the wound,traditional cross leg flap,neurocutaneous vascular cross leg flap,axial type cross leg flap pediceled with main vessel,or cross-bridge flap were chose to cover the wound surface and repair soft tissue defect.At the same time,compound external fixation devices were used to fix the fracture of affected limb,keeping the affected and unaffected limbs at a suitable posture.The pedicle of cross-bridge flap or cross leg flap was cut down 4 to 5 weeks lat...更多er after the operation.Results： All the bone exposures of the patients had harvested good coverage.None of the flaps came out to be necrosis.Because of severe local infection,chronic osteomyelitis occurred on 2 cases and they formed sinus tracts after the first operation.One healed six months postoperatively by scratching and anti-infection treatment,while another one still unhealed nearly a year postoperatively.Conclusion： Favorable outcomes can be achieved in the clinical management of bone exposure of lower limb with severe soft tissue defect using appropriate cross-leg flaps according to the situation of the wound.

关 键 词：骨外露 交腿皮瓣 桥式皮瓣 

分 类 号：R658.3[医药卫生—外科学]