胫骨皮瓣修复小腿感染性骨皮缺损的应用

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Ⅲ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，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。

CLINICAL APPLICATION OF TIBIAL BONE-SKIN FLAPS IN TREATEMENT OF INFECTIVE BONE-SKIN DEFECTS OF LEG

OBJECTIVES: To investigate the clinical therapeutic effect of tibial bone-skin flaps in the repair of infective bone-skin defects of the leg. METHODS: Between February 2000 and March 2005, 68 cases of leg infective wounds with tibial bone and skin defects were treated: 4 cases using free grafting, 64 cases using cross-leg or ipsilateral transposition grafting of tibial bone-skin flaps so that the tibial support continuity of the affected leg could be reconstructed and the wound could be covered at one stage. The skin flap area ranged from 9 cm x 4 cm to 25 cm x 12 cm and the bone flap length ranged from 6 cm to 21 cm. RESULTS: The flaps were completely survived in 67 of the 68 cases except 1 case which was repaired by fibular bone-skin flaps because of the failed blood-vessel anastomosis; the bone flaps were healed in 66 cases, except 1 case which had delayed union of the proximal end through 6-month follow-up because tibial bone flap was lengthened, leading to long soft tissue stripping of the proximal end. All the 68 patients were followed up 6 months to 5 years. The leg function and contour were satisfactory 2 years after operation. Those patients followed up more than 2 years showed normal weight loading walking without obviously abnormal gait, and can engaged in original work. CONCLUSION: On the basis of sufficient anti-infection, the one-stage reconstruction of tibial support continuity and the covering of wound by the three methods are suitable for many types of leg bone and skin defects, have a great application value and high successful rate and can retain the affected limb and create the conditions for the functional recovery.