基于骨科损伤控制理论联合股前外侧穿支皮瓣修复急性下肢毁损性创面的临床效果  

Summary and discussion of repair of acute destructive wounds in the lower limbs using damage control orthopedics theory combined with anterolateral femoral perforator flap

作　　者：杜胜虎 董雪烨 王健[1,2] 张怀保[1] 李培丰 许德孝 张麟 陶克 Du Shenghu;Dong Xueye;Wang Jian;Zhang Huaibao;Li Peifeng;Xu Dexiao;Zhang Lin;Tao Ke(Department of Wound Repair,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China;Department of Wound Repair,the Quzhou Affiliated Hospital of Wenzhou Medical University,Quzhou 324000,China;Department of Breast Surgery,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院创面修复科,温州325000 [2]温州医科大学附属衢州医院创面修复科,衢州324000 [3]温州医科大学附属第一医院乳腺外科,温州325000

出　　处：《中国医师杂志》2025年第3期367-372,共6页Journal of Chinese Physician

基　　金：浙江省医药卫生科技计划一般项目(2023KY1294);衢州市科技攻关项目(2022K52)。

摘　　要：目的总结与探讨基于骨科损伤控制(DCO)理论,联合不同形式股前外侧穿支皮瓣修复急性下肢毁损性创面的临床效果。方法回顾性分析2018年1月—2022年12月温州医科大学附属第一医院收治的33例急性下肢毁损性创面患者的临床资料,在DCO理论指导下,通过多学科会诊救治合并伤,同时一期清创、恢复骨支架、重建肢端血运、修复神经肌腱并负压封闭引流技术(VSD)敷料临时覆盖,待全身情况稳定后延期予不同形式股前外侧穿支皮瓣修复创面,缺损面积8.0 cm×5.0 cm~35.0 cm×25.0 cm,所有病例供瓣区均一期闭合。结果本组30例皮瓣术后完全存活,2例皮瓣出现远端部分坏死,予换药后创面愈合,1例皮瓣出现迟发性完全坏死。术后随访时间9~25(14.7±5.3)个月,其中2例患者因皮瓣臃肿二期予修整手术,其余患者对皮瓣重建部位及供瓣区外形满意,踝关节功能评分良好。结论基于DCO理论联合股前外侧穿支皮瓣是修复下肢毁损性创面的安全、有效的方式。ObjectiveTo summarize and discuss the clinical effect of different forms of anterolateral femoral perforator flap in the repair of acute lower extremity lesions based on the theory of damage control orthopaedics(DCO).MethodsThe clinical data of 33 patients with acute destructive wounds in the lower limbs admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2018 to December 2022 were retrospectively analyzed.Under the guidance of the DCO theory,the combined injuries were treated through multidisciplinary consultation,and at the same time,first-stage debridement,bone stent restoration,limb blood transport reconstruction,nerve tendon repair and temporary vacuum sealing drainage(VSD)dressing were applied.After the systemic condition was stabilized,the wound was repaired with anterolateral femoral perforator flaps of different forms.The defect area was 8.0 cm×5.0 cm-35.0 cm×25.0 cm,and the donor flap area was closed in one stage in all cases.Results30 cases of skin flap survived completely after operation,2 cases had distal partial necrosis,wound healing after dressing change,1 case had delayed complete necrosis.The follow-up time was 9-25(14.7±5.3)months.2 patients were treated with the second stage of repair surgery due to the bloated flap.The rest were satisfied with the shape of the reconstructed flap and the donor flap area,and the ankle joint function score was good.ConclusionsDCO theory combined with anterolateral femoral perforator flap is a safe and effective way to repair the mutilated wounds of lower limbs.

关 键 词：穿支皮瓣 损伤控制 毁损伤 创面修复 

分 类 号：R658.3[医药卫生—外科学]