腓肠神经营养血管远端蒂肌皮瓣治疗慢性跟骨骨髓炎

目的探讨应用腓肠神经营养血管远端蒂肌皮瓣治疗慢性跟骨骨髓炎的方法。方法2002年1月-2005年10月治疗7例跟骨骨折所致慢性跟骨骨髓炎,其中男4例,女3例;年龄15-68岁。均为跟骨开放性骨折或跟骨闭合性骨折切开复位内固定或植骨致切口感染、跟骨外露,骨髓炎发生,病程3-12个月。手术彻底清创后采用腓肠神经营养血管远端蒂肌皮瓣移位治疗,肌皮瓣范围为8cm×4cm-12cm×7cm,其中肌瓣范围为4cm×3cm-6cm×5cm。供区直接缝合5例,植皮覆盖2例。结果术后移位肌皮瓣完全成活,切口期愈合。7例均获2-6个月随访,皮瓣质地,外形良好。骨髓炎未见复发,无并发症发生,所有患者均恢复正常行走。结论腓肠神经营养血管远端蒂肌皮瓣治疗慢性跟骨骨髓炎是完全可行的,给跟骨骨髓炎的治疗带来了一种新方法。

DISTALLY-BASED SURAL MUSCULOCUTANEOUS FLAP FOR CHRONIC CALCANEAL OSTEOMYELITIS

OBJECTIVE: To investigate the clinical significance of the distally-based sural musculocutaneous flap for the treatment of chronic calcaneal osteomyelitis. METHODS: From January 2002 to October 2005, 7 patients (4 males, 3 females; age range, 15-68 years) were treated with the distally-based sural musculocutaneous flap, who had chronic calcaneal osteomyelitis after calcaneal fracture. After the radical debridement for all the nonviable and poorly vascularized tissues, all the chronic calcaneal osteomyelitis patients, who had suffered from open calcaneal fracture or closed calcaneal fracture, were treated with the open reduction, the internal fixation, and the bone graft. The ulcer lasted for 3-12 months before diagnosis of osteomyelitis. The musculocutaneous flaps ranged in size from 8 cm x 4 cm to 12 cm x 7 cm and the muscle flaps ranged from 4 cm x 3 cm to 6 cm x 5 cm. The donor defects were closed primarily in 5 patients and were resurfaced with the split-thickness skin graft in 2 patients. RESULTS: All the musculocutaneous flaps survived completely and all the wounds healed smoothly. All the patients followed up for 2-6 months had no recurrence of osteomyelitis or return to their preoperative ambulatory status. CONCLUSION: It is feasible to use the distally-based sural musculocutaneous flap for treatment of chronic calcaneal osteomyelitis.