吻合血管腓骨复合组织皮瓣移植修复与重建胫骨重度开放性粉碎性骨折

目的 探讨吻合血管的腓骨复合组织皮瓣移植一期固定与重建胫骨重度开放性粉碎性骨折的效果.方法 2001年2月至2007年10月收治胫骨重度开放性粉碎性骨折伴软组织缺损患者23例,男16例,女7例;年龄16～52岁,平均26.8岁.按Gustilo分型均为Ⅲ型,其中胫骨骨折累及长度11～17 cm,平均15.6 cm;小腿皮肤软组织缺损范围6 cm×3 cm～20 cm×9 cm.均采用吻合血管的腓骨复合组织皮瓣一期同时修复与重建胫骨重度开放性粉碎性骨折及胫前软组织缺损.结果 术后移植组织全部成活,皮瓣弹性、色泽良好,所有患者获得5个月～7年(平均3.5年)随访.移植腓骨与胫骨平均在1.8个月时有骨愈合征象,术后3.5～4.5个月形成良好的骨性愈合并恢复行走功能.无骨不连及骨折不愈合病例.结论 采用吻合血管的腓骨复合组织皮瓣移植可有效地对胫骨重度开放性粉碎性骨折进行修复与重建,实现一期骨折固定与胫前皮肤软组织缺损的修复.

Free composite fibular flap for repair and reconstruction of severe open tibial fractures

Objective To report our experience of using free composite fibular flap to repair and reconstruct the severe open tibial fractures at one-stage. Methods Between February 2001 and October 2007,we treated 23 cases of open tibial fracture complicated with tibial and skin defects. By Gustilo classi-fication,they were type Ⅲ. The length of tibial fracture ranged from 11 cm to 17 cm and the size of soft tissue defects ranged from 6 cm×3 cm to 20 cm×9 cm. Free composite fibula flaps were used to reconstruct the severe open comminuted fractures and to repair the soft tissue defects at one-stage. Results All the composite fibula flaps survived completely. They were followed up for an average of 3.5 years (from 5 mouths to 7 years). The bone healing time was 3.5 to 4.5 months postoperatively. The function and contour of the leg recovered satisfactorily with normal weight loading. Conclusion It is a reliable and effective method to repair massive defects of the tibia and soft tissue with free composite vascularized fibulas flaps in treatment of severe open tibial fractures.