游离组织瓣联合游离植皮负压封闭引流技术修复肢体大面积软组织缺损  

Treatment of massive soft tissue defects at extremity with a combination of free tissue flap, free skin graft and vacuum sealing drainage

作　　者：任高宏[1] 余斌[1] 王铜[1] 覃承诃[1] 黎润光[1] 蒋桂勇[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：《中华创伤骨科杂志》2012年第10期844-849,共6页Chinese Journal of Orthopaedic Trauma

基　　金：广东省自然科学基金（S2012010009434）

摘　　要：目的探讨游离绀织瓣联合游离机皮负压封闭引流（VSD）技术修复肢体严蕈创伤后大而积软组织缺损的手术技巧与临床疗效。方法2008年1月全2011年12月，应用游离组织瓣联合游离植皮VSD技术修复43例肢体严重创伤后大面积缺组织缺损患者，男32例，女11例；年龄5～66岁，平均32．5岁。创面部位：上肢10例，下肢33例；创面面积为20cm×7cm～52cm×22cm。31例合并骨折，18例合并慢性骨髓炎。忠者经彻底清创后，行外同定支架或简便内固定重建骨骼支架，然后采川VSD技术治疗。待创面新鲜肉芽组织生长后，采用不吲类刈的穿支皮瓣、肌皮瓣或肌瓣等游离组织瓣修复深部组织裸露的创而，同时行游离植皮VSD技术治疗游离组织瓣周围残留的肉芽创面。结果43例患者经清创、VSD技术治疗1～3次（平均1．8次）[5～21d（平均10．5d）]后，创面肉芽组织生长良好，感染得到控制。43例患者术后获5～32个月（平均12．6个月）随访。40例患者游离组织瓣全部成活；1例患者游离皮瓣术后出现静脉危象，经手术探查后全部成活；2例患者皮瓣远端边缘部分坏死。所有患者游离组织移植区及游离植皮区组织均成活，且质地良好、外观满意，感染控制良好，患肢功能恢复满意。结论对于肢体严垂=创伤后大耐积软组织缺损，采用游离组织瓣移植联合游离植皮VSD技术治疗可行效修复创面，最大限度地恢复患肢功能。Objective To explore surgical techniques and clinical efficacy of repairing posttraumatie massive soft tissue defects at extremity by a combination of free tissue flap, free skin graft and vacuum sealing drainage（VSD）. Methods From January 2008 to December 2011, 43 patients with posttraumatic mas- sive soft tissue defects at extremity were repaired by free tissue flap and lree skin graft covered by VSD around the flap. They were 32 males and 11 females, with an average age of 32.5 years （range, from 5 to 66 years）. Ten cases had the defects at the upper extremity and 33 below the knee. The wounds varied from 20 cmx 7 cm to 52 em × 22 cm. Thirty-one cases had a concomitant fracture and 18 concomitant chrmfie osteomyelitis. After thorough debridement, extenml fixation or simple internal fixation was applied for skeletal reconstruction. VSD was used to treat the wounds. After fi＇esh granulation tissue grew, diftkrent types of free tissue flap, like perforator flap, myoeutaneous flap and muscle flap, were harvested to repair the exposed wounds of deep tissue, especially the exposed bone. Meanwhile, the remaining wounds around the tissue flap were repaired with free skin graft covered by VSD. Results The 43 patients underwent VSD for 1 to 3 times （average, 1.8 times）, and each VSD lasted for 5 to 21 days after debridement （average, 10. 5 days）. The granulation tissues grew well and wound infections got controlled. All patients obtained an average follow-up of 12.6 months （from 5 to 32 monlhs）. Free tissue flaps survived in 40 cases, venous crisis occurred only in one ease whose flap survived after surgical exploration, and marginal necrosis occurred in 2 flaps. Finally, all the free tissue flaps transplanted and tile skin grafts covered by VSD around the free tissue flap effectively repaired the limb wounds, curing [he iuiection aud restoring satisfactory outline and function of the limb injured. Conclusion Patients with posttraumatie massive soft tissue defects at extremity can be effctively re

关 键 词：软组织损伤 外科皮瓣 引流术 显微外科手术 

分 类 号：R685[医药卫生—骨科学]