Chou Ying-Chao, Wu Chi-Chuan, Chan Yi-Sheng, Chang Chung-Hsun, Hsu Yung-Heng, Huang Yu-Chih
From the Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Hsin Street, 333, Taoyuan, Taiwan.
J Trauma. 2010 Jan;68(1):138-45. doi: 10.1097/TA.0b013e3181b064cb.
In medical literature, few articles have reported the treatment of wound complications occurring after double-plate fixation via a two-incision approach for complex tibial plateau fractures. A retrospective study was conducted to evaluate the efficacy of a medial gastrocnemius muscle flap transfer in treating this complicated disability.
We treated 16 consecutive adult patients, including 6 cases of wound complications without previous deep infection and 10 cases of wound complications with deep wound infection. A one-stage medial gastrocnemius muscle flap transfer was performed after excision of gangrened eschar in cases with wound complication after fracture fixation without infection. A staged flap transfer was performed after debridement and antibiotic administration in cases with wound complication after fracture fixation and wound infection. Bone grafting supplementation was performed in cases where a sequestrectomy had been performed.
All 16 patients were followed up for an average of 31 months (range, 13-50 months). The wound complications were successfully treated in 93.8% (15/16) of patients by medial gastrocnemius flap transfer. The fracture healed in 93.8% (15/16) of patients within an average period of 17.2 weeks (range, 10-51 weeks). One patient had gastrocnemius muscle necrosis with fracture nonunion and was treated with free vascularized muscle and osseous flap transfers. Knee function was satisfactory in 62.5% (10/16) of patients.
Medial gastrocnemius muscle flap transfer is a reliable technique for treating wound complications that occur after double-plate fixation via a two-incision approach in the treatment of complex tibial plateau fractures. A high success rate of wound healing with bone union can normally be achieved. We, therefore, recommend its widespread use in candidate patients.
在医学文献中，很少有文章报道经双切口入路双钢板固定治疗复杂胫骨平台骨折后伤口并发症的治疗情况。进行了一项回顾性研究，以评估腓肠肌内侧头肌瓣转移治疗这种复杂残疾的疗效。
我们连续治疗了16例成年患者，其中6例为无既往深部感染的伤口并发症患者，10例为有深部伤口感染的伤口并发症患者。骨折固定后无感染的伤口并发症患者，在切除坏疽焦痂后进行一期腓肠肌内侧头肌瓣转移。骨折固定后有伤口并发症且伤口感染的患者，在清创和使用抗生素后进行分期肌瓣转移。在进行了死骨切除术的病例中进行骨移植补充。
16例患者均获随访，平均随访31个月（范围13 - 50个月）。93.8%（15/16）的患者通过腓肠肌内侧头肌瓣转移成功治疗了伤口并发症。93.8%（15/16）的患者骨折在平均17.2周（范围10 - 51周）内愈合。1例患者出现腓肠肌坏死伴骨折不愈合，接受了游离带血管肌肉和骨瓣转移治疗。62.5%（10/16）的患者膝关节功能满意。
腓肠肌内侧头肌瓣转移是治疗经双切口入路双钢板固定治疗复杂胫骨平台骨折后出现的伤口并发症的可靠技术。通常可实现较高的伤口愈合及骨愈合成功率。因此，我们建议在合适的患者中广泛应用。
