Peat B G, Liggins D F
Middlemore Hospital, Auckland, New Zealand.
Ann Plast Surg. 1990 Jun;24(6):517-20. doi: 10.1097/00000637-199006000-00007.
Forty-three patients underwent microvascular free flap reconstruction of severe acute compound tibial fractures between 1980 and 1987. Thirty-three patients with follow-up of one to three years were retrospectively reviewed. Time to bone union took an average of 37 weeks; 30% developed infection necessitating bone removal, and 2 patients required amputation for infected nonunion. Infection rates were lower for the free muscle flaps than for the free skin flaps. No correlation was drawn with the type of fracture, but a delay in wound closure was associated with a higher infection rate. All adult patients required bone grafting, with the least infection seen with the free vascularized bone flaps. Immediate fresh bone grafting at the time of free flap reconstruction, compared with delayed bone grafting, showed no added risk of infection.
1980年至1987年间，43例患者接受了严重急性复合胫骨骨折的微血管游离皮瓣重建术。对33例随访1至3年的患者进行了回顾性研究。骨愈合时间平均为37周；30%的患者发生感染，需要进行骨切除，2例患者因感染性骨不连而需要截肢。游离肌皮瓣的感染率低于游离皮瓣。未发现感染率与骨折类型相关，但伤口闭合延迟与较高的感染率相关。所有成年患者均需要植骨，游离带血管蒂骨瓣的感染率最低。与延迟植骨相比，在游离皮瓣重建时立即进行新鲜骨移植并未增加感染风险。
