逆行腓骨短肌肌瓣修复跟骨骨折术后骨外露临床体会

目的探讨逆行腓骨短肌肌瓣在修复跟骨骨折术后骨外露的可行性.方法自2007年1月至2010年2月收治跟骨骨折内固定术后所致骨外露病例11例,其中男7例,女4例,年龄18～50岁,平均35.2岁;开放性骨折3例,闭合性骨折8例,手术原切口均为跟骨外侧"L"形切口,跟骨解剖型钢板内固定.创面缺损范围1.5cm×2.3cm～3.0cm×4.0cm,病程为2-4个月;所有病例均进行多次换药不见好转.手术时首先给予原切口扩创,清除坏死组织和炎性肉芽组织,取出内固定物.设计并切取同侧腓骨短肌逆行肌瓣充填缺损区,观察血运良好后,表面予以中厚游离皮片覆盖,打包加压,石膏托固定2周,供区均直接缝合.结果所有病例术后转移肌瓣及植皮完全成活,仅1例伴肌瓣下感染,换药后愈合.11例患者随访时间为2-20个月,平均4.5个月;术后皮瓣质地、外形良好,足踝活动稳定,无并发症发生,均可正常行走,无疼痛.结论逆行腓骨短肌肌瓣修复跟骨骨折术后骨外露,操作简单、成功率高、并发症少,可获得满意临床疗效.

The clinical analysis of reverse peroneus brevis muscle flaps for bone exposure after the operation of calcaneus fracture

Objective To investigate the feasibility of reverse peroneus brevis muscle flaps for bone exposureafter the operation of calcaneus fracture. Methods From January 2007 to Feburary 2010, there were 11 cases （7 males and 4 females） of bone exposure after the operation of calcaneus fracture with internal fixation. The average age was 35.2 years （range; 18-50）. 3 cases were of opening fracture and 8 cases were of closed fracture. All patients had ＂L＂ incision on the lateral calcaneus site and were fixed with anatomical plate. The area of soft tissue defect was 1.5×2.3cm- 3.0×4.0cm. The course of disease ranged from 2 months to 4 months. Incisions of all the patients were not improved after dressing changes many times. The internal plate was dropped out after incision expansion and debridement of necrotic tissue and inflammatory granulation tissue. Peroneus brevis muscle flap was transferred reversly to repair of the soft tissue defects. With the development of blood circulaition, the surface was covered with the split thickness skin graft and compressed with gauze pack. The donate zone was sutured directly, and then the treatment of external piaster fixation for 2 weeks was recommended. Results All the transferred muscle flaps and grafted skin survived completely, except for 1 case with infection under muscle flap, which was cured through changing fresh dressing for wound. The follow-up of 11 patients was from 2 months to 20 months, and the average course was 4.5 months. The texture and contour of flap were fine, and the activity of foot and ankle was stable without any complication. All the patients could walk regularly without any pain. Conclusions Repairation of bone exposure caused by operation of calcaneus fracture with reverse peroneus brevis muscle flap may be simple and can yield satisfied clinical effect with higher success rate and less complication.