摘要
目的探讨上肢GustiloⅢB、ⅢC型开放性骨折伴软组织缺损二期创面修复的临床疗效。方法2014年7月至2016年7月，共收治19例上肢GustiloⅢB、ⅢC型开放性骨折伴软组织缺损的患者，其中GustiloⅢB型12例，ⅢC型7例，男14例，女5例，年龄22～59岁，平均42岁。所有患者均分期处理，一期急诊行清创＋固定，同时修复肌腱、神经、血管，创面大小3em×4cm～7cm×36cm，术后VSD覆盖创面。除1例患者于术后5d截肢外，其余18例患者均二期行皮瓣移植，应用股前外侧穿支皮瓣修复10例，背阔肌肌皮瓣3例，上臂外侧皮瓣5例。结果保肢成功的18例患者中1例股前外侧皮瓣远端部分坏死，切除后植皮存活，1例皮瓣术后产生血管危象，积极探查处理后远端5cm发生坏死，后期切除后植皮愈合，其余皮瓣均完全存活。1例创面浅表感染；1例皮瓣供区浅表感染，反复扩创后植皮愈合，其余皮瓣供区愈合良好。手术次数2～6次，平均住院34d（12～71d）。保肢成功的18例患者均获7—23个月随访（平均14．5个月），皮瓣质地均柔软；有不同程度的色素沉着；皮瓣感觉恢复，其中s24例，s39例，S45例；1例供区瘢痕增生明显，其余17例无明显瘢痕增生。结论二期法修复上肢GustiloⅢB、ⅢC型开放性骨折伴皮肤软组织缺损效果满意，患者耐受性较好，皮瓣成活率高。
Objective To investigate the clinical therapy for Gustilo type Ⅲ B, Ⅲ C open fractures with skin and soft tissue defects on the upper extremities. Methods From July 2014 to July 2016, 19 patients with Gustilo type Ⅲ open fractures （type ⅢB 12 cases , type ⅢC 7 cases） and soft- tissue defects in upper extremity were admitted, including 14 males and 5 females , aged 22 to 59 years （average 42 ）. All the cases were treated by staged treatment. In the first stage, early debridement, nerves, vessels and tendons repairment, fixation of the fractures, VSD for the wound were performed. One patient underwent amputation 5 days after first operation. All the other 18 patients received flap transplantion, including 10 anterolateral thigh perforator flaps, 3 latissimus dorsal muscular flaps and 5 free lateral arm flaps. Results 8 patients were followed up for an average duration of 14.5 months （ranged from 7 to 23 months）. Partial necrosis happened at the distal end of one anterolateral thigh perforator flap and healed with skin - grafting. 1 flap encountered vascular complication which survived with 5em - in - width skin necrosis at the distal end of the flap after successful surgical exploration. 1 case had superficial infection at wound. The wounds at donor sites were primarily healed except for 1 ease with skin graft necrosis and superfieial infection. All the other flaps survived completely. The patients received 2 -6 operations each. The average hospital stay was 34 days （12-71 days）. All Skin flap texture was soft and had varying degrees of pigmentation. The flap sensory recovery was S2 in d cases, S3 in 9 cases, S4 in 5 cases. 1 case had obvious scar hyperplasia. Conclusions Staged surgical treatment in Gustilo type Ⅲ open fractures with soft - tissue defects in upper extremity provide a high survival rate of flaps and satisfactory results. The treatment is well tolerate by patients.
出处
《中华整形外科杂志》
CSCD
北大核心
2017年第5期345-349,共5页
Chinese Journal of Plastic Surgery
基金
基金项目：无锡市科技发展资金项目（CSE32N1303）
江苏省医学领军人才与创新团队项目（LJ201114）
关键词
骨折
开放性
软组织损伤
组织移植
Fractures, open
Soft tissue injury
Tissue transplantation
