摘要
目的探讨穿支蒂螺旋桨皮瓣治疗下肢骨折术后切口愈合不良的临床疗效。方法采用回顾性病例系列研究分析2013年2月-2016年2月应用穿支蒂螺旋桨皮瓣修复40例下肢骨折术后出现皮肤坏死，导致肌腱、骨或内固定外露等切口愈合不良患者的临床资料，其中男28例，女12例；年龄19—65岁，平均42．7岁。跟骨骨折术后外侧切口周围皮肤坏死或切口愈合不良伴内固定外露17例，pilon骨折术后前侧切口愈合不良伴肌腱、内固定外露11例，胫骨远端骨折术后内侧切口愈合不良伴内固定外露8例，外踝骨折术后外侧切口愈合不良伴内固定外露4例。根据皮瓣成活情况、感染控制、弹性色泽、外观形态、供区瘢痕、皮肤感觉、患者认可度等七个方面对皮瓣修复术后的疗效进行评价，并采用美国足踝外科协会（AOFAS）踝-后足功能评分。结果患者均获随访5-21个月，平均12．3个月。术后1例皮瓣出现血管危象，予以对症处理后缓解。患者皮瓣成活良好，形态满意，色泽、弹性与周围正常组织接近；供区创面无感染，愈合瘢痕较小。本组满意32例，一般8例，无不满意。根据AOFAS踝-后足功能评分，优18例，良21例，可1例。结论穿支蒂螺旋桨皮瓣治疗下肢骨折术后部分切口愈合不良、出现皮肤坏死甚至肌腱、内固定外露，疗效良好，值得临床推广。
Objective To investigate the clinical efficacy of pedicled perforator propeller flaps for incision poor healing after the surgery of lower extremity fractures. Methods A retrospective case series analysis was made on 40 patients managed with pedicled perforator propeller flaps for incision poor healing caused by skin necrosis after surgery of lower extremity fractures from February 2013 to February 2016. There were 28 males and 12 females, with a mean age of 42.7 years （range, 19-65 years）. In all, 17 patients were noted with skin necrosis or poor healing of the lateral incision complicated by internal fixation exposure after calcaneal fracture surgery, 11 poor anterior incision healing complicated by poor tendon and internal fixation exposure after pilon fracture surgery, 8 poor medial incision healing complicated by poor internal fixation exposure after distal tibial fracture surgery, and 4 poor lateral incision healing complicated by internal fixation exposure after lateral malleolus fracture surgery. Surgical efficacy was evaluated in terms of the flap survival rate, infection control, elasticity, color and appearance of skin, donor site scar, skin sensation, and patient acceptance. American Orthopedic Foot and Ankle Society （AOFAS） ankle-hindfoot scale was recorded after operation. Results Duration of follow-up was 5-21 months （mean, 12.3 months）. One patient suffered from vascular crisis after operation and was cured after symptomatic treatment. All flaps survived with the appearance, color and elasticity close to the surrounding normal skin. Donor sites exhibit no infection and were healed with small scarring.Acceptance was satisfactory in 32 patients and ordinary in 8 patients. According to the AOFAS scale, the results were excellent in 18 patients, good in 21 and fair in 1. Conclusion Perforator pedieled propeller flaps are effective in treatment of incision poor healing after surgery of lower extremity fractures and deserve to be popularized in clinics.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2017年第2期118-122,共5页
Chinese Journal of Trauma
基金
浙江省公益性技术应用研究计划（2015C33195）
关键词
外科皮瓣
手术后并发症
螺旋桨皮瓣
Surgical flaps
Postoperative complications
Propeller flaps
