桥式皮瓣联合游离植皮负压封闭引流修复下肢大面积环形软组织缺损  

Treatment of large circular soft tissue defect in lower extremities with a combination of bridge flaps and free skin graft covered by vacuum sealing drainage

作　　者：任高宏[1] 黎健伟[1] 黎润光[1] 王钢[1] 余斌[1] 

机构地区：[1]南方医科大学南方医院创伤骨科,广州510515

出　　处：《中华外科杂志》2012年第1期39-44,共6页Chinese Journal of Surgery

摘　　要：目的探讨健侧胫后血管皮瓣桥携带游离皮瓣的桥式皮瓣联合游离植皮负压封闭引流（VSD）治疗下肢严重创伤后大面积环形软组织缺损的临床应用价值。方法2008年1月至2010年6月，应用桥式皮瓣联合游离植皮VSD治疗11例患者，年龄15—52岁，平均32．5岁，男性7例，女性4例，均为下肢严重创伤后深部组织裸露或坏死感染的大面积环形软组织缺损，6例同时合并骨折。经彻底清创后，对不稳定骨折行外固定支架固定或简便内固定，然后采用VSD治疗1．2次，每次5～7d。待创面肉芽组织生长较新鲜后，采用桥式皮瓣移植修复患侧骨及深部组织裸露的创面，皮瓣周围残留的创面采用游离植皮VSD覆盖修复。术后对皮瓣移植区及皮片植皮区的存活情况和愈合质量进行随访。结果11例患者经清创负压封闭引流5—14d后，创面肉芽组织生长良好。再次清创后应用桥式皮瓣移植联合游离植皮VSD覆盖治疗，皮瓣移植区组织全部成活且质地、外观满意，感染控制良好，未形成窦道。6例游离植皮区由于面积较大术后遗留部分散在创面，4例经再次植皮，2例经积极换药后均完全消灭创面，游离皮瓣移植成功率100％。术后随访5—24个月，平均10．6个月，皮瓣质地柔软，外形良好，患肢功能恢复满意。结论对于严重创伤后深部组织裸露的下肢大面积环形软组织缺损，VSD覆盖技术可有效修复创面，最大限度地恢复患肢的功能。Objective To explore the surgical technique and clinical value of treatment for posttraumatic large circular soft tissue defect in the lower extremities using a combination of posterior tibial vascular bridge flap in the unaffected leg and skin graft covered by vacuum sealing drainage （VSD）. Methods From January 2008 to June 2010, 11 cases with posttraumatic large circular soft tissue defects with deep tissue exposed or partial necrosis in the lower extremities were treated by bridge flaps and combined with free skin graft covered by VSD. There are 7 males and 4 females, with an average age of 32. 5 years （range from 15 to 52 years）. The size of wound varied from 24 cmx 13 cm to 45 cm x24 cm. After the wound were completely debrided, the external fixation or internal fixation was conducted for the patients with unstable fracture. Then VSD were used to covered the wound for 1-2 times with a period of 5 to 7 days according to the wound condition. After granulation tissue grew, bridge flap transplantation was performed to repair tissue defect and cover the exposed bone, which combined with skin graft covered by VSD was used to cover the residual wound. Survival rate and quality healing of the flaps were followed up postoperatively. Results The granulation growth of 11 cases with large circular soft tissue defect in the lower extremities associated tissue exposure was good after the application of VSD. All the cases were covered by free flap transplantation and skin grafting except for 6 eases due to large defect. The wound was covered by skin re-grafting in 4 cases and frequently dressing change in 2 cases. All the flaps were successful with good infection control and no sinus. The average period of follow-up was 10. 6 months （5-24 months）. All the patients were satisfied with the good outline and good function of the affected limb. Conclusion Patients with posttraumatic large circular soft tissue defect in the lower extremities can be effectively treated with a combination of bridge flaps and free skin

关 键 词：外科皮瓣 软组织损伤 引流术 显微外科手术 

分 类 号：R687[医药卫生—骨科学]