皮瓣联合外固定架治疗胫骨骨折伴小腿软组织缺损

目的 探讨小腿软组织缺损伴有胫骨骨折或骨缺损、骨髓炎的有效治疗方法。方法 对45例小腿大面积软组织缺损同时伴有胫骨骨折或骨缺损、骨髓炎的病例，采用游离皮瓣腓肠神经营养血管皮瓣和筋膜皮瓣及腓肠肌内、外侧头肌皮瓣转位等加外固定架结合的方法治疗。结果 除1例骨髓炎外，全部病例小腿创面均愈合。采用半环架与皮瓣结合治疗37例，其骨折愈合时间为6～14个月；力臂式外固定架的6例愈合时间为1年～2年8个月；组合式外固定的2例愈合时间为1年2个月。结论 半环架与皮瓣结合是治疗小腿大面积软组织缺损伴有骨折、骨缺损或骨髓炎的一种良好方法。

Combinaton of flap and external fixator for complex soft tissue defects of the leg associated with tibia fractures

Objective To investigate the method of treatment for the soft-tissue defects of the leg associated with tibia fractures,defects,or osteomyelitis. Methods Forty-five cases of large soft-tissue defects of the leg associated with tibia fractures,defects and osteomyelitis were treated with free flaps or sural neurocutaneous vascular flaps or fasciocutaneous flaps or musculoflaps of the gastrocnemius heads combined with different external fixators. Results All the legs healed,except one with osteomyelitis. The bone healing time for the 37 cases treated with flaps and semicircle external fixators was from 6 to 14 months. This for the 6 cases treated with unilateral axial dynamic fixators was from 12 to 32 months and for 2 cases with assembly external fixator 14 months. Conclusions The combination of the semicircle external fixator and flap is a satisfactory method for large area soft tissue defects of the leg associated with fractures,bone defects and ostemyelitis.