拱顶石皮瓣修复长骨骨折内固定术后软组织缺损并钢板外露  

Keystone flap in reconstruction of soft tissue defect with plate exposure after internal fixation of long bone fracture

作　　者：艾尔班江·沙力 伊力亚尔·吾买尔江 买买艾力·玉山 任鹏[1,2] 程二林 艾合买提江·玉素甫 AIERBANJIANG Shali;YILIYAER Wumaierjiang;MAIMAIAILI Yushan;REN Peng;CHENG Erlin;AIHEMAITIJIANG Yusufu(Department of Microsurgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China;Xinjiang Key Laboratory of Trauma Repair,Urumqi 830011,China)

机构地区：[1]新疆医科大学第一附属医院显微外科,乌鲁木齐830011 [2]新疆维吾尔自治区创伤修复重点实验室,乌鲁木齐830011

出　　处：《中华显微外科杂志》2024年第2期165-171,共7页Chinese Journal of Microsurgery

基　　金：天山英才科技创新领军人才-高层次领军人才(2022TSYCLJ0026)。

摘　　要：目的探讨拱顶石皮瓣(KF)修复四肢长骨骨折内固定术后软组织缺损并钢板外露的临床疗效。方法2019年10月-2023年8月,共11例四肢长骨骨折内固定术后钢板外露患者在新疆医科大学第一附属医院显微外科应用KF修复创面,钢板外露创面3例位于胫骨,5例位于腓骨,2例位于肱骨,1例位于尺骨。钢板外露原因包括缝合张力过大、局部感染严重、软组织损伤严重、低蛋白血症、糖尿病、长期吸烟和小腿深静脉血栓合并小腿肿胀,钢板外露后软组织缺损面积为8.0 cm×3.0 cm~20.0 cm×4.0 cm,设计KF的面积为12.0 cm×8.0 cm~24.0 cm×12.0 cm。应用KF类型为ⅡA型7例、Ⅲ型3例、Ⅳ型1例;所有患者定期门诊随访,观察皮瓣外观和术后并发症,皮瓣外观使用温哥华瘢痕量表(VSS)、瘢痕外观评估和评定量表(SCAR)进行评分和分析。结果术后随访3~48(15.91±10.23)个月,10例患者未出现皮瓣坏死、感染、伤口裂开和静脉(或淋巴)回流障碍等并发症,仅1例术后2个月再次出现钢板外露,待骨折愈合后拆除钢板并修复创面,所有患者KF移植区域的颜色、质地与周围正常皮肤相近,感觉恢复良好;末次随访VSS评分为(2.72±0.66)分,SCAR评分为(4.90±0.66)分,修复结果满意。结论KF作为一个多穿支蒂皮瓣,可以有效利用局部软组织移行潜力转移修复钢板外露所导致的软组织缺损,避免使用复杂的带血管蒂的组织瓣及游离皮瓣,并可有效控制感染。Objective To explore the clinical efficacy of Keystone flap(KF)in reconstruction of soft tissue defect with plate exposure after internal fixation of long bone fractures of four limbs.Methods From October 2019 to August 2023,a total of 11 patients with exposed plates after internal fixation of limb fractures were treated by KF to reconstruct the soft tissue defects in the Department of Microsurgery of the First Affiliated Hospital of Xinjiang Medical University.Of the exposed internal fixation plates,3 were located in the tibia,5 in the fibula,2 in the humerus and 1 in the ulna.Causes of exposure of internal fixation plate included excessive tension of suture,severe local infection,severe soft tissue injury,hypoalbuminemia,diabetes,and long-term smoking and calf deep vein thrombosis with swelling calf.The areas of soft tissue defect after the plate exposure were measured 8.0 cm×3.0 cm-20.0 cm×4.0 cm in size.The sizes of KF were 12.0 cm×8.0 cm-24.0 cm×12.0 cm.Seven patients were treated with typeⅡA KF,3 with typeⅢKF and 1 with type IV KF.All patients were included in the postoperative follow-up by visiting of outpatient clinics to observe the appearance of the flaps and postoperative complications.Appearances of the flaps were assessed and analysed according to Vancouver Scar Scale(VSS)and Scar Cosmesis Assessment and Rating(SCAR).Results During the 3~48(15.91±10.23)months of follow-up,no complication such as flap necrosis,infection,wound split and disorder of venous-lymphatic drainage occurred in 10 patients.One patient had the plate re-exposure at 2 months after surgery,and the wound was repaired after the fracture had healed and removal of the plate.The colour and texture of the transferred KFs were similar to those of the surrounding normal skin in all patients,with good sensation recovery.At the final follow-up,the VSS score achieved at 2.72 points±0.66 points and the SCAR score at 4.90 points±0.66 points.The outcomes of the surgery were satisfactory.Conclusion As a multi-perforator pedicled flap,t

关 键 词：拱顶石皮瓣 长骨骨折 钢板外露 骨折 感染 

分 类 号：R687.3[医药卫生—骨科学]