托毒生肌法结合隐动脉胫骨皮瓣修复小腿骨皮缺损23例

目的探讨托毒生肌法结合隐动脉胫骨皮瓣修复小腿骨皮缺损的疗效。方法对23例小腿粉碎性骨折并严重软组织损伤后形成骨皮缺损、胫骨骨髓炎患者行托毒生肌方外洗加病灶清除隐动脉胫骨皮瓣修复术。术后镇痛、抗凝、血管活性、抗炎药物等对症治疗,内服中药补益气血、扶正祛邪,可见光照射,观察皮瓣血液循环。结果 23例骨皮瓣全部成活,断蒂后6个月～14个月在积极功能锻炼下,患者膝、踝关节功能基本恢复。3例术后出现静脉回流障碍,给予抬高患肢、消肿治疗后好转。4例术前缺损面积较大、感染程度较深,术后出现骨皮瓣周围渗出较多,给予抗生素、中药内服,换药后病情好转。结论托毒生肌法结合隐动脉胫骨皮瓣修复小腿骨皮缺损,疗效确切。

23 Cases of Leg Bone-skin Defect Treated with Expelling Toxin and Promoting Tissue Regeneration Therapy Combined with Saphenous Arterial Tibia-Skin Flap

Objective To explore the efficacy of expelling toxin and promoting tissue regeneration therapy combined with saphenous arterial tibia-skin flap on leg bone-skin defect.Methods The expelling toxin and promoting tissue regeneration therapy for external rinsing combined with saphenous arterial tibia-skin flap on the lesion was applied to 23 cases of bone-skin defect after leg fragmental fracture and serious soft tissue damage,as well as tibial osteomyelitis.After surgery,the symptomatic treatment was administered for analgesia,anti-coagulation,vascular activity,anti-inflammation,etc.Additionally,Chinese herbal decoction for internal administration was used to tonify qi and blood,strengthen the antipathogenic qi and eliminate pathogenic factors.Besides,the visible light radiation was applied and flap blood circulation was observed.Results All the 23 cases of skin flaps were survived.In 6 to 14 months after pedicle cutting,the knee and ankle joint function was recovered basically after active functional exercise.3 cases had postoperative venous return obstruction,which was relieved after the affected limb elevation and swelling-removal treatment.4 cases had quite large defect area and deep infection before operation.After operation,the infiltration occurred around skin flap,which was relieved after internal administration of antibiotics and Chinese herbal medicine,as well as dressing.Conclusion The expelling toxin and promoting tissue regeneration therapy for external rinsing combined with saphenous arterial tibia-skin flap has definite efficacy on leg bone-skin defect.