负压封闭引流联合皮瓣治疗下肢严重软组织缺损

目的探讨采用负压封闭引流技术(VSD)联合皮瓣治疗合并严重软组织缺损的开放性骨折的疗效。方法将58例下肢开放性骨折合并严重软组织缺损的患者分为两组:对照组(27例)给予普通清创,二期内固定并植皮或皮瓣转移修复创面;VSD组(31例)急诊清创后采用一期内固定联合VSD固定骨折并封闭创口,7～21 d后根据肉芽生长情况给予二期缝合、植皮或皮瓣转移。结果骨折愈合时间:对照组6～18(9.8±2.91)个月,VSD组4～10(6.29±1.88)个月,差异有统计学意义(P<0.05)。创面愈合时间:对照组20～95(46.81±16.80)d,VSD组14～33(19.68±5.30)d,差异有统计学意义(P<0.01),GustiloⅢA型与ⅢB型骨折两组骨折愈合时间差异无统计学意义(P>0.05),而创面愈合时间差异有统计学意义(P<0.01、P<0.05)。结论 VSD联合皮瓣能够明显缩短合并严重软组织并骨缺损的开放性骨折的治疗周期。

Vacuum sealing drainage plus flap in the treatment of leg open fracture with severe soft tissue defect

Objective To explore the efficacy of using vacuum sealing drainage(VSD) for the treatment of open fracture with severe soft tissue defect.Methods 58 patients with lower limb open fracture and severe soft tissue defect were divided into two groups.Control group(27 cases) was treated by debridement,and delayed skin transplantation or local flap graft,and internal fixation.VSD group(31 cases) was treated by debridement,internal fixation,and the wound surface being covered with VSD at the same time.The wounds were closed with secondary suturing,or skin transplantation,or local flap graft 7 to 21 d after debridement.Results Time of bone union were:6~18(9.8±2.91) months in the control group,and 4~10(6.29±1.88)months in the VSD group(P<0.05).Time of wound surface healing were: 20~95(46.81±16.80)d in the control group,and 14~33(19.68±5.30)d in the VSD group(P<0.01).There was no significant difference in the time of bone union between Gustilo ⅢA and Gustilo ⅢB(P>0.05).But the wounds healing time of Gustilo ⅢA was significantly shorter than ⅢB in the two groups respectively(P<0.01,P<0.05).Conclusions VSD can shorten the wounds healing time of open fracture with severe soft tissue defect.