摘要
目的探讨应用携带股外侧肌的游离股前外侧肌皮瓣修复小腿开放粉碎性骨折合并大面积皮肤缺损的复杂性创面临床疗效。方法回顾性分析2019年1月-2021年6月本院收治的小腿开放粉碎性胫腓骨骨折(GustiloⅢb及GustiloⅢc)合并大面积皮肤缺损复杂性创面共10例患者的病例资料,均在稳定生命体征前提下,对创面彻底清创止血,钢板或外固定架维持骨折后,探查并修复血管神经肌腱,对于大面积皮肤缺损,予以清创后可以应用持续封闭负压引流(VSD)覆盖创面或者一期应用携带股外侧肌的游离股前外侧肌皮瓣覆盖创面,皮肤缺损面积:6 cm×10 cm~10 cm×30 cm,评价临床疗效。结果10例患者肌皮瓣均成活,其中2例大腿供区植皮部分坏死,经换药创面愈合;1例因受区创面未完全覆盖,经再次清创换药后伤口延迟愈合;术后随访6~18个月,骨折顺利愈合,小腿功能和外观恢复良好。结论应用携带股外侧肌的游离股前外侧肌皮瓣灵活调整切取,既可将携带的股外侧肌填塞覆盖骨及肌肉缺损空腔,也可将肌肉组织与皮瓣灵活调整移动度,增加覆盖面积,对于开放粉碎性骨折合并大面积皮肤缺损的复杂性创面的修复有较大的优势,有助于患者早期康复。
Objective To investigate the effect of free anterolateral thigh myocutaneous flap with lateral thigh muscle on the repair of complex wound bed with open comminuted fracture of lower leg and large skin defect.Methods Retrospective analysis was made on the case data of 10 patients with open comminuted tibial and fibular fractures(GustiloⅢb and GustiloⅢc)of the lower leg and complicated wounds with large skin defects treated in our hospital from January 2019 to June 2021.All patients were given thorough debridement and hemostasis on the premise of stable vital signs.After the fracture was maintained with steel plate or external fixator,the vassel nerve tendon was explored and repaired.For large skin defects,After debridement,continuous sealing negative pressure drainag(VSD)or one-stage application of free anterolateral thigh myocutaneous flap with lateral thigh muscle to cover the wound,with a skin defect area of(6 cm×10 cm)-(10 cm×30 cm)to evaluate the clinical efficacy.Results All 10 flaps patients survived,2 of them had partial necrosis of the skin graft in the thigh donor area,and the wound healed after dressing change;One case had delayed healing after debridement and dressing change because the wound in the receiving area was not completely covered;follow up of 6-18 months showed that the fracture healed smoothly,and the leg function and appearance recovered well.Conclusion The free anterolateral thigh myocutaneous flap with lateral thigh muscle can be flexibly adjusted and cut,which can not only fill the cavity of bone and muscle defects with lateral thigh muscle,but also flexibly adjust the mobility of muscle tissue and flap.The increased coverage area has great advantages for the repair of complex wounds with open comminuted bone folding and large skin defects,which is helpful for early rehabilitation of patients.
作者
李忠文
郝宝辉
徐帅令
汤浩
吴信举
周兴
唐怀龙
朱自强
LI Zhongwen;HAO Baohui;XU Shuailing(Department of Hand and Foot Surgery,Xuzhou Mining Group General Hospital,Xuzhou,Jiangsu,221000,China)
出处
《实用手外科杂志》
2024年第3期315-319,共5页
Journal of Practical Hand Surgery
