创伤性胫前皮肤缺损骨不连医源性因素分析及防治

目的探讨外伤性胫前皮肤缺损骨不连医源性因素、治疗方法及预防措施.方法对136例外伤性胫前皮肤缺损,进行回顾性研究,分析医源性因素,提出预防措施,随访治疗效果.采用7种局部转移皮瓣和6种游离皮瓣移植治疗皮肤缺损,骨不连、骨缺损均采用带血管的骨移植.结果136例中121例得到6～28个月随访,平均17个月.局部皮瓣转移全部成活,游离皮瓣移植中7例术后发生血管危象,经探查4例成活,3例失败,二期以带胫后血管的对侧小腿内侧皮瓣为受区血管蒂的皮瓣移植修复治愈.骨不连、骨缺损行骨移植后均在术后3个月愈合,骨髓炎治愈.结论医源性技术缺陷是外伤性胫前皮肤缺损骨不连的重要因素,针对各种不同的因素进行预防、合理治疗可获得满意效果.

Iatrogenic Factors and Prevention of Traumatic Anterior Tibial Skin Defect and Tibial Nonunion

Objective To investigate the iatrogenic factors, the treatment method and the prevention of traumatic anterior tibial skin defect and tibial nonunion. Methods The retrospective study in 136 patients with traumatic anterior tibial skin defect was performed, including 36 patients with bone defect or bone nonunion and 16 patients with osteomyelitis. The iatrogenic factors were analyzed, the prevention methods were put forward and the treatment results were followed up. The treatment methods were that the anterior tibial skin defect was covered with seven types of regional transferred flaps and six types of free transplanted flaps. The bone defect or bone nonunion was repaired with vascularized bone grafts. Results One hundred and twenty-one patients were followed up from six months to twenty- two months, seventeen months on average. All of the regional transferred flaps survived. The vascular crisis occurred in seven vascularized free flaps and four flaps survived after vascular exploration while three failed. The failed flaps were repaired with free flaps vascularized by contralateral posterior tibial vessel on the second stage. All tibial bone nonunion and bone defect were united three months after surgery and osteomyelitis was cured. Conclusion The surgeon's surgical technique is the main factor in traumatic anterior tibial skin defect and tibial nonunion. The prevention and rational therapy aiming at various kinds of factors can acquire the satisfactory result.