毁损性骨外露坏死的整形修复

目的：采用4种方法修复各部位毁损性损伤及骨外露坏死创面，依据不同部位损伤大小、深度和形态探索最佳的整形治疗方案。方法：①骨面植皮裸露骨钻洞培养肉芽后皮片移植，毁损的死骨咬除到板障层或裸露软骨面皮片移植；②传统皮瓣、皮管移植修复骨外露；③筋膜瓣覆盖骨外露创面后皮片移植；④早、晚期头皮扩张囊扩张皮瓣带毛发移植修复颅骨外露坏死及毛发缺失创面。结果：86例毁损性骨外露创面，Ⅰ期手术修复58例，Ⅱ期修复24例，4例创面感染和死骨残余未清除彻底而失败，经换药控制感染后再次手术修复成功。结论：依据各部位的毁损性骨外露创面程度，形态及全身情况，选择相应的修复方法，不但创面得以覆盖，也能取得良好的外观整形效果。

Reconstruction and repair of the necrotic wounds with exposed bones post destructive injury

Objective To explore 4 sorts of surgical methods and choose the optimal reconstructive and reparative treatments for necrotic wounds with exposed bones post destructive injury. Methods （1）Skin graft was used to cover the healthy granulation tissues which cultured above the diploic and chondral layers after removing the necrotic bones or trephinating on necrotic and wxposed bones. （2）Traditional skin flaps and tubed skin flaps were used to repair the wounds with exposed necrotic bones. （3）Skin graft above the superficies of the fascia flaps which covered the wounds on exposed necrotic bones. （4）The primary and secondary scalp expanded flaps graft were used to repair the necrotic wounds with exposed bones. Results Of 86 cases,58 cases were closed primarily, 24 cases healed by secondary operation and 2 cases were failure because the wounds were infected and the necrotic bones were not removed completely. The wounds were covered successfully after controlling the wound infection by dressingex change. Conclusions To choose the suitable way to repair the wound with exposed bones could acquire the satisfactory appearance and successful closure by the size and type of the wounds and whole-body situation.