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1、·30·ChineseJReparativeandReconstructiveSurgery,2007,Vol21(1)胫骨皮瓣修复小腿感染性骨皮缺损的应用贾红伟程春生吕松峰赵作恭单海民杜志军汤金城任飞【摘要】目的探讨胫骨皮瓣在修复小腿感染性骨皮缺损中的应用及效果。方法2000年2月～2005年3月,收治因外伤致小腿开放性骨折68例。男47例,女21例,年龄8～59岁。按Gustilo分型均为Ë型。其中4例一期行胫骨皮瓣游离移植术,64例急诊术后形成小腿感染性骨皮缺损。胫骨缺损长度4～18cm,
2、皮肤缺损范围8cm×3cm～22cm×11cm,创面均有脓性渗出物。经中药薰洗湿敷后,利用胫骨皮瓣通过游离移植、交腿移位和同侧移位方法,重建患肢胫骨支架连续性并修复创面。切取皮瓣范围9cm×4cm～25cm×12cm,骨瓣长度为6～21cm。结果术后1例因血管危象经探查再吻合血管失败,改用腓骨皮瓣修复。1例切取胫骨皮瓣21cm,因近端为延长血管蒂,骨膜与骨瓣剥离过长,随访6个月近端仍延迟愈合;余患者3～5个月骨瓣与受区胫骨愈合。68例均获随访6个月～5年,43例随访2年以上者均能负重行走,步态无
3、明显异常,能从事原工作。结论在充分抗感染的基础上,根据患肢具体情况采用胫骨皮瓣游离移植、交腿移位和同侧移位一期重建胫骨支架连续性及修复皮肤缺损创面,适用于小腿多种类型骨皮缺损创面,成功率高,能保留患肢,为功能恢复创造条件。【关键词】骨皮缺损胫骨皮瓣修复小腿中图分类号:R622R658.3文献标识码:ACLINICALAPPLICATIONOFTIBIALBONE-SKINFLAPSINTREATEMENTOFINFECTIVEBONE-SKINDE-FECTSOFLEGöJIAHongwei,C
4、HENGChunsheng,LVSongfeng,etal.LuoyangOrthopedic2TraumatologicalHospi2talandInstituteofHenanProvince,LuoyangHenan,471002,P.R.ChinaCorrespondingauthor:JIAHongwei,E2mail:lyduwei@126.com【Abstract】ObjectivesToinvestigatetheclinicaltherapeuticeffectoftibia
5、lbone2skinflapsintherepairofin2fectivebone2skindefectsoftheleg.MethodsBetweenFebruary2000andMarch2005,68casesofleginfectivewoundswithtibialboneandskindefectsweretreated:4casesusingfreegrafting,64casesusingcross2legoripsilateraltranspo2sitiongraftingo
6、ftibialbone2skinflapssothatthetibialsupportcontinuityoftheaffectedlegcouldbereconstructedandthewoundcouldbecoveredatonestage.Theskinflaparearangedfrom9cm×4cmto25cm×12cmandtheboneflaplengthrangedfrom6cmto21cm.ResultsTheflapswerecompletelysurvivedin67o
7、fthe68casesexcept1casewhichwasrepairedbyfibularbone2skinflapsbecauseofthefailedblood2vesselanastomosis;theboneflapswerehealedin66cases,except1casewhichhaddelayedunionoftheproximalendthrough62monthfollow2upbecausetibialboneflapwaslengthened,leadingtol
8、ongsofttissuestrippingoftheproximalend.Allthe68patientswerefollowedup6monthsto5years.Thelegfunctionandcontourweresatisfactory2yearsafteroperation.Thosepatientsfollowedupmorethan2yearsshowednormalweightloadingwalkingwithoutobviouslyabnormalgait,andcan
