骨搬移联合皮瓣移植术在小腿医源性感染治疗中的应用

目的总结骨搬移联合皮瓣移植术修复胫骨骨折内固定术后医源性感染导致皮肤软组织及骨缺损的经验。方法自2009-06—2013-02诊治13例胫骨骨折内固定术后医源性感染而发生骨髓炎患者,皮肤软组织缺损采用游离皮瓣进行修复;骨缺损修复二期进行,均采用Ilizarov环形外固定架作为牵张和外固定支具。结果 13例均获得随访6~48个月,平均14个月。10例创面一期愈合,3例皮瓣部分坏死,再次行交腿皮瓣和局部皮瓣转移修复,1例成功,2例因感染迁延不愈而截肢。11例骨再生良好,6例骨端一期愈合,5例完成牵张过程后二次手术植骨愈合。结论 Ilizalov技术能很好地促进骨缺损后骨的再生,结合皮瓣移植术治疗医源性感染后发生的骨髓炎效果良好。

Application of combining surgical skin flap grafting and bone transplanting in treatment of nosocomial infection of shank

Objective To sum up experience of combining surgical skin flap grafting and bone transplanting in treating soft tissue and bone defects caused after nosocomial infection after internal fixation of tibial fracture. Methods From Jun. 2009 to Feb. 2013, 13 cases of osteomyelitis caused after nosocomial infection after internal fixation of tibial fracture were treated. Soft-tissue defects were repaired using free skin flap. Bone defects were repaired at second stage, and Ilizarev external fixator was used as a tool of distraction osteogenesis. Results The mean follow-up period was 14 months（range, 6 to 48 months）. Of all the flaps, wound healed on schedule in 10 cases whereas 3 cases emerged part necrosis, underwent cross leg skin flaps and local flap a second time, 1 case succeed but 2 cases received amputation due to incurable and reversal infection. Osteanagenesis accomplished on schedule in 11 cases, 6 of which knitted well, while bone grafting were operated between bone stumps in 5 cases. Conclusion The Ilizarov technique is a certified method solving bone defects and leads to osteoanagenesis, moreover, skin flap grafting （transferring） is needed frequently for skin covering following limbs wound, both above are beneficial to infection control and lead to satisfied results.