足踝部创伤后严重复合组织缺损感染创面的修复  

Repair of infected composite tissue wounds at the ankle or foot

作　　者：张春[1] 崔海宁 郭峭峰[1] 沈立锋[1] 辛龙[1] 张展[1] 鲁宁[1] 

机构地区：[1]浙江省立同德医院骨伤科,杭州310012 [2]浙江省东阳市人民医院骨科

出　　处：《中华创伤骨科杂志》2012年第10期859-862,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨足踝部创伤后严西复合组织缺损感染创而的治疗方法及疗效。方法回顺性分析2006年3月至2012年3月收治的120例足踝部创伤后严畦复合组织缺损感染创面患者资料，男100例，女20例；年龄4～80岁，平均41．1岁。受伤至手术时间为1个月至3年。皮肤软组织缺拟面积为3．0cm×1．5cm～23．0cm×12．0cm。单纯皮瓣修复创面20例，皮瓣＋载抗生素可吸收人工骨（RBK）修复57例，皮瓣＋RBK＋白体髂骨机骨43例。先行清创、VSD技术治疗创丽者108例，清创后直接皮瓣修复创而者12例时骨折内吲定失效仍需固定者改片外固定支架固定。结果120例患者术后扶3个月至5年（平均15个月）随访。106例患者术后伤口一期愈合，14例患暂二期愈合。6例患者皮瓣或儿儿皮瓣出现部分坏死，均为带蒂转位者。113例患者骨髓炎一期渝愈，骨折愈合时间为4～8个月，平均5．2个月；3例出现骨不愈合患者再次行自体髂骨植骨，6～8个月后治愈；2例跟骨骨髓炎患者术后复发，经再次手术后状况良好；另有2例虽经皮瓣移植创而川合，但仍残留窦道换药．需再次手术、结论对于足踝部创伤后严重复合组织缺损感染创而，根据不同份情，应用VSD技术、RBK、皮瓣、叽皮瓣转位或移植技术可取得良好疗效。Objective To evaluate the elinieal outeomes of repairing inieted composite tissue wounds at the ankle of fool using vaeuum sealing drainage （VSD）, OsteoSel Resorbahle Mini-Bead Kit （PtBK） implantation and skin or row）cutaneous grafts. Methods Included in the present study were 120 patients with infe,：ted romposite lissne wounds at the ankle or foot who had been treated in our department frnm March 2006 to March 2012. They were 100 nmles and 20 females, aged fi＇om 4 to 80 years （average, 41. 1 yearsi. The time from injury to surgelT, ranged from one month to 3 years. The areas of soft tissue wound ranged from 3.0 cm × 1.5 em to 23.0 cmm × 12.0 cm. Twenty eases were treated with skin or myoeutaneous flaps, 57 eases with flaps plus RBK implantation, and 43 eases with flaps plus RBK plus aulogenie lilac graft. Thorough debridement followed hy VSD covering was used in 108 eases and thorough deridement fi,llowed by direct skin or myoeutanenus grafting in 12 eases. If the internal fixation of ankle or runt fracture failed, external fixation was applied instead. Results All patients were followed up for 3 months In 5 years （average, 15 months）. Primary healing was aehieved in 106 eases, and secondary healing in 14 eases. All the grafts survived well except 6 ones that had partial necrosis tbllowing pedieled transposition. Ostenmyelitis was cured at one stage in 113 eases which oblained bone union after 4 to 8 months （average, 5.2 months）. Bone nonunion oecurred in 3 cases which were cured witll autogenic iliac graft after 6 to 8 months. Two cases of chronic ealeaneal osteomyelilis experienced reeurrenee which as cm＇ed after secondary, operation, Two other cases received seeoadat.＇y operation because of sinus tract formation after removal of drainage tube. Conclusion VSD, RBK implantation and skin or my_ oeutaneous grafts are effective ways In treat infected composite tissue wounds at the ankle or foot.

关 键 词：引流术 软组织损伤 外科皮瓣 感染 

分 类 号：R622[医药卫生—整形外科]