负压封闭引流及皮片移植修复胫腓骨骨折的皮肤软组织缺损

背景：传统的治疗胫腓骨骨折合并皮肤软组织缺损的方法是行简单外固定，创面清创换药待感染控制、肉芽生长旺盛后植皮或皮瓣转移，这种方法不仅费用高、痛苦大、住院时间长，而且有感染扩散、周围组织进一步坏死，最后不得不截肢的可能。目的：探讨封闭负压引流加外固定架修复胫腓骨骨折并皮肤缺损的临床疗效。方法：选择本溪市中心医院2009年1月至2013年9月收治胫腓骨骨折皮肤软组织缺损患者38例，皮肤缺损面积〉5 cm2，在骨折外固定后给予彻底清创，再行封闭负压引流技术治疗5-7 d，待肉芽组织生长、创面新鲜后行中厚皮片植皮治疗。并回顾性选择15例未采用封闭负压引流治疗的类似病例作为对照组，对其感染控制率及伤口愈合时间等进行比较。结果与结论：引流5-7d后去除封闭负压引流敷料，伤口感染得到控制，局部创面肉芽组织生长良好，创面及骨折均如期愈合，无骨髓炎及截肢的发生。38例患者治愈23例，显效12例，无效3例，总有效率为92%，与对照组53%的总有效率相比差异有显著性意义（P〈0.05）。证实封闭负压引流可以彻底清除创面的分泌物和坏死组织，改善局部微循环和消除感染，联合外固定支架和植皮是治疗胫腓骨骨折并软组织缺损的一种简便有效方法。

Vacuum sealing drainage plus skin transplantation repair skin soft tissue defects in tibia and fibula complicated fractures

BACKGROUND：Traditional treatment of tibia and fibula fractures complicated with skin soft tissue defect is mainly external fixation, wound debridement and dressing plus skin graft or skin flap transplantation after the infection is control ed and granulation grow. This method is disadvantageous due to high cost, great pain, long hospitalization stay, infection and necrosis, even the possibility of amputation. OBJECTIVE：To explore the clinical efficacy of vacuum sealing drainage （VSD） and external fixator in the treatment of tibia and fibula open fractmes complicated with skin defects. METHODS：A total of 38 patients with severe open fractures of tibia and fibula complicated with skin defects were selected from Benxi Central Hospital between January 2009 and September 2013. The size of skin defects was more than 5 cm2. After external fixation, the patients underwent complete debridement and dressing, fol owed by VSD treatment for 5-7 days. After granulation tissue grew and the wound became fresh, the patients received intermedite thickness skin graft. And 15 cases treated without VSD were retrospectively selected, serving as control group. The infection control rate and wound healing time in the two groups were compared. RESULTS AND CONCLUSION：After 5-7 days of VSD treatment, VSD dressings were removed, wound infection was control ed, local wound granulation tissue was fresh. Both the wound and fractures were healed wel , no osteomyelitis or amputation occurred. Among the involved 38 patients, 23 cases were cured, 12 cases were effective, and three cases were ineffective. The total effective rate showed significant differences compared with the control group （92%vs. 53%;P〈0.05）. VSD can completely remove the wound secretions and necrotic tissue, improve local microcirculation, eliminate the infection, VSD plus external fixator and skin grating is a simple and＆nbsp;effective method in treatment of tibia and fibula open fractures with soft tissue defects.