摘要
目的探讨负压封闭引流（VSD）技术结合肌瓣转移游离植皮治疗小腿及足踝部大面积软组织缺损伴骨外露的疗效。方法2006年3月至2011年12月共收治52例小腿及足踝部大面积软组织缺损伴骨外露患者，男37例，女15例；年龄24～66岁，平均38．9岁；软组织缺损面积：20cm×15cm～35cm×30cm，骨外露面积：6cm×4cm～10cm×5cm。开放性骨折按Gustilo分型：ⅢA型17例，ⅢB型35例。急诊清创后利用邻近肌瓣转移最大限度覆盖骨外露，缩小骨外露范围，裸露骨质钻数个小孔后使用VSD技术治疗。待创面肉芽组织生长良好后，采用游离植皮术联合持续VSD技术修复创面。小腿及足踝部功能按Lowa踝关节评分标准评定。结果52例患者应用VSD技术治疗1～4次，骨外露被完全覆盖时间为6～29d，平均18．2d。所有患者术后获6个月至5年（平均为2年8个月）随访，所有患者软组织缺损区的创面肉芽组织生长快、质地好，骨外露被快速生长的肉芽组织所覆盖，创面游离植皮全部成活。骨折愈合时间为3～6个月（平均4个月）。5例发生跟腱挛缩致马蹄足畸形，后期行矫正术。无合并感染、骨坏死和慢性骨髓炎等并发症发生。小腿及足踝部功能按Lowa踝关节评分标准评定：优9例，良33例，可8例，差2例，优良率为80．8％。结论VSD技术结合肌瓣转移游离植皮治疗小腿及足踝部大面积软组织缺损伴骨外露，可避免截肢和复杂手术，是一种简单、快捷、有效的治疗方法。
Objective To explore the efficacy of free skin graft and muscle flap transfer combined with vacuum sealing drainage （VSD） in repairing soft tissue defects complicated with bone exposure at the lower extremity and ankle. Methods From March 2006 to December 2011, 52 patients with large soft tissue defect and bone exposure at the lower extremity and ankle were in our department. They were 36 males and 15 females, with an average age of 38, 9 years （from 24 to 66 years）. The sizes of wound varied from 20 cmx 15cmto35cm×30 cm and areas of bone exposure from 6 cm× 4cmto10cm× 5cm. According to the Gustilo classification, 17 cases were of type ⅢA and 35 of type ⅢB. After emergency debridement, adjacent muscle flaps were transferred to cover the exposed bone as much as possible. Several small holes were drilled in the remaining exposed bone before VSD was applied to cover the wound. After granulation tissue grew, free skin graft followed by VSD was performed to repair soft tissue defects, Results VSD was applied from one to 4 times in the 52 patients. The time for complete coverage of the exposed bone ranged from 6 to 29 days （average, 18.2 days） . The patients were followed up for 6 months to 5 years, with an average of 2 years and 8 months. The granulation tissue grew well enough to cover the exposed bone in all cases. All the skin grafts were successful. The average union time of the fractures was 4 months （from 3 to 6 months）. Equinus deformity occurred in 5 cases due to achilles tendon eontraeture but was corrected operatively. There was no infection, osteoneerosis or osteomyelitis. According to the Lowa system, 9 cases were rated as excellent, 33 as fine, 8 as fair and 2 as poor, giving an excellent-to-good rate of 80.8%. Conclusion It is simple, fast, effective to apply free skin graft and muscle flap transfer combined with VSD to repair soft tissue defects complicated with bone exposure at the lower extremity and ankle, because amputation and complicated procedures can be spared.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2013年第4期316-319,共4页
Chinese Journal of Orthopaedic Trauma
基金
河北省医学科学研究重点课题计划（20090633）
关键词
下肢
引流术
腿损伤
软组织损伤
Low extremity
Drainage
Leg injuries
Soft tissue injuries
