摘要
目的探讨游离腓肠内侧动脉穿支肌皮瓣修复骨髓炎创面的可行性。方法回顾性分析2017年6月至2019年5月,在宁波市第一医院住院治疗的17例骨髓炎伴软组织缺损的患者资料,其中男11例,女6例,年龄21~76岁,平均53.2岁,缺损面积为5 cm×4 cm^13 cm×6 cm,均为慢性创面。术前应用微泡增强超声、超声三维血管重建及定位膜联合CTA辅助设计皮瓣。对骨髓炎创面进行彻底清创,应用抗生素骨水泥覆盖创面,根据药敏结果应用抗生素,待创面稳定后,切取以腓肠内侧动脉穿支为蒂的游离肌皮瓣进行修复,供区均直接缝合。术后予抗感染、抗痉挛、抗凝等治疗,应用红外热像仪对皮瓣血供进行观察。结果17例皮瓣完全成活,皮瓣面积为6 cm×4 cm^13 cm×7 cm,供区均一期直接缝合。术后1例出现皮缘坏死,仔细换药后愈合,遗留色素沉着,余16例皮瓣顺利成活,无血管危象等相关并发症。随访4~23个月,所有皮瓣质地、色泽良好,稍突出于皮肤表面,供区愈合可,无相关并发症,同时骨髓炎得到有效控制,患者较为满意。结论应用游离腓肠内侧动脉穿支肌皮瓣修复骨髓炎创面,可获得良好的临床效果。
Objective To investigate the clinical effect of free medical sural artery perforator myocutaneous flap for repairingof the woundwith osteomyelitis.Methods 17 patients suffered from the wound with osteomyelitis were treated in the Ningbo First People′s Hospital,There were 11 males and 6 females with an mean age of 53.2 years(range,21-76 years).The sizes of the defect ranged 5 cm×4 cm to 13 cm×6 cm.All patients underwent debridement and used antibiotic-loaded bonecement to cover the wound.Meanwhile,patients were treated with sensitive antibiotics,operation and free medical sural artery perforator myocutaneous flap were used to treat the wound.Preoperative use ultrasound and CT angiography to positioning perforator,The flap area ranged from 6 cm×4 cm to 13 cm×7 cm and the donor sites were closed directly.The author provided the patients with the treatment of anti-inflammatory,anti-spasmodic and anti-coagulantin the postoperative.Used infrared thermograms to assess the flap blood supply.Results One flap skin margin was non union due to poor blood supply.All of the other 16 flaps success survived and the donor sites were closed directly.Postoperative follow-up period was 4 to 23 months and the flaps had satisfied texture and appearance.All the donor sites had a good healing with no pain and complications,also the osteomyelitis was controlled.Conclusions The free medical sural artery perforator myocutaneous flap is reliable for reconstruction of the wound with osteomyelitis.
作者
林光豪
陈芝武
郑钧水
杨专
任甜甜
虞煜
王扬剑
魏鹏
Lin Guanghao;Chen Zhiwu;Zheng Junshui;Yang Zhuan;Ren Tiantian;Yu Yu;Wang Yangjian;Wei Peng(Department of Reconstructive Surgery,Ningbo First Hospital,Ningbo 315000,China)
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2019年第12期1234-1239,共6页
Chinese Journal of Plastic Surgery
基金
宁波市自然科学基金(2017A610183)。
关键词
骨髓炎
肌皮瓣
腓肠内侧动脉穿支
重建
Osteomyelitis
Medial suralartery perforator
Myocutaneous flap
Reconstruction
