Boopalan P R, Nithyananth Manasseh, Titus V T, Cherian Vinoo Mathew, Jepegnanam Thilak S
Department of Orthopaedics, Unit 3, Christian Medical College, Vellore, Tamil Nadu, India.
J Emerg Trauma Shock. 2011 Jul;4(3):325-9. doi: 10.4103/0974-2700.83806.
Optimal care of open, high-velocity, lower limb injury requires surgical skills in debridement, skeletal stabilization, and in providing appropriate soft tissue cover. Timely coordination between orthopedic and plastic surgeons, though ideal, is often difficult. In our center, orthopedic surgeons undertake comprehensive treatment of open fractures including soft tissue cover. We reviewed the results of the local flaps of lower limb, done by orthopedic surgeons.
We retrospectively reviewed the results of the lower limb flaps done between January 2005 and December 2006. All flaps done at and below the level of knee were included.
There were 105 patients with 120 flaps during this period. Two patients with two flaps were lost to follow-up. The average age was 32 years. Sixty-four patients had Type IIIB Gustilo and Anderson injuries. Thirty-nine patients had isolated soft tissue injuries. The indications for flaps were exposed bone, tendon, and joint in 45, 11, and 12, respectively, or a combination in 35 patients. The flaps done were 51 reverse sural artery, 35 gastrocnemius, 25 local fasciocutaneous, and seven foot flaps. The flap dimensions ranged from 2 × 2 to 30 × 15 cm. Ninety-three flaps (79%) healed primarily. Among 25 flaps (21%) with necrosis, 14 flaps required secondary split skin graft for healing, while the other nine flaps healed without further surgery.
Appropriate soft tissue cover provided by orthopedic surgeons can help in providing independent, composite care of lower limb injuries.
开放性、高速下肢损伤的最佳治疗需要清创、骨骼固定及提供合适软组织覆盖的手术技能。骨科医生与整形外科医生之间及时协调虽理想，但往往很难实现。在我们中心，骨科医生承担包括软组织覆盖在内的开放性骨折的综合治疗。我们回顾了由骨科医生实施的下肢局部皮瓣手术的结果。
我们回顾性分析了2005年1月至2006年12月期间所做下肢皮瓣手术的结果。纳入所有在膝关节及以下部位实施的皮瓣手术。
在此期间，有105例患者接受了120例皮瓣手术。2例患者的2例皮瓣失访。平均年龄为32岁。64例患者为III B型 Gustilo 和 Anderson 损伤。39例患者为单纯软组织损伤。皮瓣手术的适应证分别为45例暴露的骨、11例肌腱、12例关节，或35例患者为上述情况的组合。所做皮瓣包括51例腓肠神经营养血管皮瓣、35例腓肠肌皮瓣、25例局部筋膜皮瓣和7例足部皮瓣。皮瓣面积范围为2×2至30×15cm。93例皮瓣（79%）一期愈合。在25例（21%）发生坏死的皮瓣中，14例皮瓣需要二期植皮愈合，另外9例皮瓣无需进一步手术即愈合。
骨科医生提供合适的软组织覆盖有助于对下肢损伤进行独立的综合治疗。
