May J W, Jupiter J B, Gallico G G, Rothkopf D M, Zingarelli P
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
Ann Surg. 1991 Sep;214(3):241-50; discussion 250-2. doi: 10.1097/00000658-199109000-00007.
During a 13-year period at the Massachusetts General Hospital, Boston, Massachusetts, 97 microvascular free tissue transfers have been performed for soft-tissue reconstruction in 96 patients following bone debridement for chronic traumatic bone wounds. These 96 patients comprise a continuation study of 18 original patients reported in 1982. During a 13-year follow-up period (mean, 77.1 months), 95.8% of these 96 patients have enjoyed complete wound closure with a lack of drainage after the debridement and free tissue transfer. Most of the patients (89.6%) encountered in this study are ambulatory without assist and 5.2% of patients have undergone amputation. Twenty-three per cent of patients required subsequent segmental bone defect reconstruction in the lower extremity after infection eradication. The pathophysiology of chronic traumatic bony wounds is different from that of chronic hematogenous osteomyelitis and thus a high incidence of long-term successful management can be seen through complete wound debridement and adequate soft-tissue coverage.
在马萨诸塞州波士顿市的麻省总医院，历经13年时间，针对96例慢性创伤性骨伤口清创术后的患者，实施了97例微血管游离组织移植术以进行软组织重建。这96例患者是对1982年报告的18例原始患者的延续性研究。在长达13年的随访期（平均77.1个月）内，这96例患者中有95.8%在清创和游离组织移植后实现了伤口完全闭合且无引流。本研究中大多数患者（89.6%）无需辅助即可行走，5.2%的患者接受了截肢手术。23%的患者在感染消除后需要对下肢后续的节段性骨缺损进行重建。慢性创伤性骨伤口的病理生理学与慢性血源性骨髓炎不同，因此通过彻底的伤口清创和足够的软组织覆盖，可实现较高的长期成功治疗率。
