锁定加压钢板外置结合下腹壁联体皮瓣治疗胫骨开放性骨折合并软组织缺损
Chinese Journal of Microsurgery（2022）
Abstract
目的:探讨锁定加压钢板（LCP）外置结合下腹壁联体皮瓣治疗胫骨开放性骨折合并软组织缺损的临床疗效。方法:回顾性分析2017年8月-2020年12月收治的18例胫骨严重开放性骨折患者,男15例,女3例；年龄25~58岁,中位年龄38岁。致伤原因：交通事故伤9例,高处坠落伤3例,重物砸伤6例。其中Gustilo III B型6例,III C型12例。一期急诊扩创探查、外置胫骨LCP复位固定骨折块及VSD处理；二期根据缺损部位及范围,制备携带足够长度血管蒂的下腹壁联体皮瓣,腹部供区均一期闭合。采用电话加微信方式随访。结果:本组术后除1例皮瓣因静脉危象探查无效,腓肠肌肌皮瓣转位覆盖原位缺损外,其余皮瓣全部成活,供、受区创面均Ⅰ期愈合。患者均获随访,随访时间12~18个月,平均15个月；骨折愈合良好,无骨感染、骨不愈合等；皮瓣外形满意,质地柔软,未出现明显色素沉着；供区仅遗留线形瘢痕,未出现腹壁疝等并发症。末次随访时按Johner-Wruhs评分达优12例,良6例。结论:一期外置LCP可以解放膝、踝关节及保护局部软组织,二期游离双蒂下腹壁联体皮瓣可覆盖大面积软组织缺损,两者结合显著降低术后感染率、减少手术次数及缩短住院时间。
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Key words
Conjoined flap,Inferior abdominal wall,External locking compression plate,Tibia, open fracture,Soft tissue defect
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