不同类型的组织瓣修复胫骨近端骨折术后钢板外露伴感染创面的临床效果  

Clinical effects of different types of tissue flaps in repairing the wounds with steel plate exposure and infection after proximal tibial fracture surgery

作　　者：刘文剑[1] 张红艳[2] 刘德伍[2] Liu Wenjian;Zhang Hongyan;Liu Dewu(Department of Burns and Plastic Surgery,Jiangxi Provincial General Hospital of Armed Police,Nanchang 330030,China;Medical Center of Burn Plastic and Wound Repair,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]武警江西总队医院烧伤整形科,南昌330030 [2]南昌大学第一附属医院烧伤整形与创面修复医学中心,南昌330006

出　　处：《中华烧伤与创面修复杂志》2023年第12期1140-1148,共9页Chinese Journal of Burns And Wounds

摘　　要：目的探讨不同类型的组织瓣修复胫骨近端骨折术后钢板外露伴感染创面的临床效果。方法采用回顾性观察性研究方法。2015年1月—2021年12月,武警江西总队医院收治11例符合入选标准的胫骨近端骨折术后钢板外露伴感染创面患者,其中男9例、女2例,年龄26~61岁。创面位于小腿近端外侧者5例、内侧者2例,小腿近端内侧及膝下胫前者4例,清创后创面面积为14 cm×6 cm~22 cm×11 cm,采用不同类型的组织瓣修复创面,并根据钢板周围感染情况决定是否立即拆除钢板。应用以包含旋股外侧动脉降支终末细小分支的肌肉为蒂的逆行股前外侧肌皮瓣者3例;应用腓肠肌内侧头肌瓣联合比目鱼肌内侧半肌瓣者6例,应用腓肠肌外侧头肌瓣联合胫前肌肌瓣者2例,肌瓣血运稳定后移植健侧大腿薄中厚皮片封闭创面。肌皮瓣切取面积为15 cm×7 cm~18 cm×8 cm,肌瓣切取面积为6.0 cm×4.0 cm~18.0 cm×12.0 cm。3例应用逆行股前外侧肌皮瓣的患者中2例大腿供瓣区创面经直接缝合关闭,在1例患者大腿供瓣区创面缝合后未闭合处移植健侧大腿薄中厚皮片予以修复。将8例应用小腿肌瓣者供瓣区切口直接缝合。术后观察并记录组织瓣成活情况和肌瓣上移植皮片存活情况、组织瓣受区创面愈合情况及愈合时间、供瓣区缝合口愈合及移植皮片存活情况。记录术后及随访期间是否拆除钢板。随访时,观察组织瓣外形及质地,组织瓣受区有无红肿、破溃或窦道形成;记录骨折愈合时间。末次随访时,测量患者膝关节屈伸活动度并根据Hohl膝关节功能评定标准评价膝关节功能,测定8例应用小腿肌瓣修复创面的患者踝关节跖屈肌力;采用温哥华瘢痕量表(VSS)评估供瓣区瘢痕情况,观察瘢痕是否影响患肢活动。结果11例患者术后组织瓣均成活;1例患者逆行股前外侧肌皮瓣的远端皮肤坏死,行换药+健侧大腿薄中厚皮片移植后创Objective To investigate the clinical effects of different types of tissue flaps in repairing the wounds with steel plate exposure and infection after proximal tibial fracture surgery.Methods A retrospective observational study was conducted.From January 2015 to December 2021,11 patients with steel plate exposure and infected wounds after proximal tibial fracture surgery who met the inclusion criteria were admitted to Jiangxi Provincial General Hospital of Armed Police,including 9 males and 2 females,aged 26 to 61 years.The wounds were located on the lateral side of the proximal leg in 5 cases,on the medial side of the proximal leg in 2 cases,and on the medial side of the proximal leg and the anterior tibia below the knee in 4 cases.After debridement,the wound area was 14 cm×6 cm-22 cm×11 cm.The wounds were repaired with different types of tissue flaps,and the steel plates were removed immediately if necessary,according to the infection around the steel plates.The reverse anterolateral thigh myocutaneous flap pedicled with the muscle containing the terminal small branch of the descending branch of the lateral circumflex femoral artery was used in 3 cases;the medial gastrocnemius muscle flap combined with the medial half of soleus muscle flap was used in 6 cases,and the lateral gastrocnemius muscle flap combined with the anterior tibial muscle flap was used in 2 cases.After the muscle flaps had stable blood supply,the wounds were closed with thin intermediate thickness skin graft from the healthy thigh.The area of myocutaneous flap ranged from 15 cm×7 cm to 18 cm×8 cm,and the area of muscle flap ranged from 6.0 cm×4.0 cm to 18.0 cm×12.0 cm.Among the 3 patients who were treated with reverse anterolateral thigh myocutaneous flap,the wounds of flap donor site on thighs were closed by direct suturing in 2 cases,and the wound in the flap donor site of thigh in 1 case that was not closed after suture was repaired with thin intermediate thickness skin graft from healthy thigh.The incisions in the flap donor sites o

关 键 词：胫骨骨折 外科皮瓣 肌皮瓣 显微外科手术 创面修复 感染创面 骨 

分 类 号：R687.3[医药卫生—骨科学] R622[医药卫生—外科学]