骨外固定架与髂骨皮瓣移植联合应用治疗小腿骨及软组织缺损

目的探讨骨外固定架与髂骨皮瓣移植I期联合修复胫骨缺损伴小腿软组织缺损的方法和临床效果。方法对28例胫骨及其周围软组织缺损早期应用骨外固定架与髂骨皮瓣移植治疗。皮肤缺损面积：5cm×5cm～9cm×20cm;手术切除皮瓣面积：5cm×7cm～12cm×23cm;切取髂骨块5cm×3.5cm～10cm×3.5cm。对于较大面积的骨皮组织缺损,应用同时携带旋髂深及旋髂浅双血管蒂的髂骨皮瓣移植治疗。结果髂骨植骨骨性愈合时间31周,无不愈合病例。骨皮瓣全部存活,无感染、坏死,外形及功能恢复满意。结论早期应用单侧外固定支架与髂骨皮瓣移植联合是修复合并骨及软组织缺损的小腿严重创伤的一种良好方法,双血管蒂为骨皮瓣的存活提供了可靠保障。

External fixation and cutaneous iliac flap grafting to the treatment of leg bone and soft tissues defects

Objective To explore the methods and clinical effects of primary repair for the defects of the tibia and soft tissues of leg by using external fixation and cutaneous iliac flap grafting. Methods Early external fixation and cutaneous iliac flap grafting were performed for the treatment of 28 cases of the defects of the tibia and soft tissues. The areas of skin defects and the harvested skin flaps were 5 cm ×5 cm -9 cm ×20 cm and 5 cm x7 cm × 12 cm ×23 cm respectively; and the iliac bones harvested were 5 cm × 3.5 cm - 10 cm × 3.5 cm. For those with large defects, the flaps were done with both deep and superficial circumflex iliac vessels anastomoses. Results The time of the bony healing for iliac implant was 31 weeks, without non-union case. All the cutaneous iliac flaps survived, with no infection or necrosis. The recovery of their appearances and functions were satisfactory. Conclusions Early unilateral external fixation with cutaneous iliac flap grafting is a good method for repairing the severe trauma of the leg with defects of bone and soft tissues, and the double blood vessels anastomoses guarantees the survival of the cutaneous iliac flaps.