应用外固定架及封闭式负压引流联合腓肠神经营养血管逆行岛状皮瓣治疗胫、腓骨开放骨折合并皮肤软组织缺损  

External fixation and closed suction drainage combined with reverse sural neurocutaneous island flap in treatment of tibia and fibula open fractures with skin and soft tissue defects

作　　者：侯占江[1] 刘明辉[1] 周世峰[1] 樊昌东[1] 夏昊晨[1] 

机构地区：[1]哈尔滨医科大学附属第一医院急诊外科,黑龙江哈尔滨150001

出　　处：《哈尔滨医科大学学报》2011年第4期346-348,351,共4页Journal of Harbin Medical University

摘　　要：目的总结应用外固定架及封闭式负压引流联合腓肠神经营养血管逆行岛状皮瓣治疗胫、腓骨开放骨折合并皮肤软组织缺损的效果。方法 2008年6月～2009年6月,胫、腓骨开放骨折18例,患者均行骨折复位外固定架固定。清创后创面范围为5 cm×4 cm～12 cm×9 cm。均采用积极清创后平均16 d VSD治疗,待创面肉芽组织新鲜、感染控制后,采用大小为6 cm×5 cm～13 cm×8 cm腓肠神经营养血管逆行岛状皮瓣修复创面。结果皮瓣术后1例出现皮瓣远端皮缘坏死,1例术后3 d皮瓣因蒂部缝合过紧压迫出现静脉回流不良,均经对症处理后成活,其余皮瓣顺利成活,切口Ⅰ期愈合。皮瓣与周围皮肤色泽相似,无臃肿,质地佳。术后皮瓣受力处无破溃,无骨髓炎复发。结论应用外固定架及封闭式负压引流联合腓肠神经营养血管逆行岛状皮瓣是治疗三度小腿骨折合并皮肤软组织碾挫缺损有效方法之一。Objective To summarize the application of external fixation and closed suction drainage combined with reverse island skin flap nourished by the nutrient vessels （SFNV） of the sural nerve in treatment of tibia and fibula open fractures with skin and soft tissue defects. Methods External fixation and vacuum sealing drainage （VSD） combined with reverse island skin flap nourished by SFNV of the sural nerve was used to repair skin defects of lower onethird of the leg, foot or ankle with tibia and fibula open fractures in 18 patients from July 2008 to June 2009. The sizes of wounds debridement were 5 cm × 4 cm - 12 cm × 9 cm. First a positive therapy with VSD was used in mean 16 days after debridement, fracture reduction and external fixation. After the fresh granulation tissues grew and infections in control, defects were repaired by sural neurovaseular island flap （size from 6 cm ×5 cm to 13 cm ×8 cm）. Results There was a small amount of distal marginal necrosis in 1 case after operation, and a venous stagnation of island flap occurred at 3 days after flap transposition caused by tight sutures in 1 case, which survived after appropriate treatment. Remaining flaps survived well and with cut I healing. The skin of flap was similar to the surrounding skin, with no fat and good texture. No ulceration was seen in the zones of pressure on the free flap, and no recurrence of osteomyelitis. Conclusion Application of external fixation and closed suction drainage combined with nutrient vessels of sural nerve island flap is an effective method for treatment of lower leg fracture with three grinding frustration of skin and soft tissue defects.

关 键 词：封闭式负压引流 腓肠神经逆行岛状皮瓣 胫腓骨开放骨折 

分 类 号：R683.42[医药卫生—骨科学]