Kalra Gurdayal Singh, Goel Pradeep, Singh Pradeep Kumar
Department of Burn and Plastic Surgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
Indian J Plast Surg. 2013 Sep;46(3):543-8. doi: 10.4103/0970-0358.122013.
The severe long bone defects usually follow high-energy trauma and are often associated with a significant soft-tissue injury. The goal of management of these open long bone defects is to provide stable fixation with maintenance of limb length and soft-tissue coverage. The purpose of this article is to present the clinic-radiological outcome, complications and treatment of post-traumatic long bone defect with vascularised fibula transfer.
Retrospective records of 28 patients were analysed who presented with post-traumatic long bone defects and in whom reconstruction with vascularised free fibula was done. Demographic data were recorded and clinical and radiological assessment was done.
Out of 28 patients in whom vascularised free fibula transfer was carried out three flaps were lost while non-union occur in three patients. Three patients developed a stress fracture of transferred free fibula in the post-operative period. Few of the patients experienced some problems in the donor leg; however, all of them improved in subsequent follow-up.
It is clearly evident from this study that timing of surgery plays an important role in the micro-vascular reconstruction in trauma cases. All the complication like flap loss, non-union or delayed union occur in patients in whom reconstruction was delayed.
The free vascularised fibula graft is a viable method for the reconstruction of skeletal defects of more than 6 cm, especially in cases of scarred and avascular recipient sites or in patients with combined bone and soft-tissue defects. Results are best when the reconstruction is done within 1 week of trauma.
严重的长骨缺损通常继发于高能创伤，且常伴有严重的软组织损伤。治疗这些开放性长骨缺损的目标是提供稳定固定，同时维持肢体长度和软组织覆盖。本文旨在介绍带血管蒂腓骨移植治疗创伤后长骨缺损的临床放射学结果、并发症及治疗方法。
对28例创伤后长骨缺损并行带血管蒂游离腓骨重建的患者的回顾性记录进行分析。记录人口统计学数据，并进行临床和放射学评估。
在接受带血管蒂游离腓骨移植的28例患者中，3个皮瓣坏死，3例发生骨不连。3例患者术后发生移植的游离腓骨应力性骨折。少数患者供肢出现一些问题；然而，所有患者在随后的随访中均有改善。
从本研究中明显可以看出，手术时机在创伤病例的微血管重建中起着重要作用。所有并发症，如皮瓣坏死、骨不连或延迟愈合，均发生在重建延迟的患者中。
带血管蒂游离腓骨移植是重建超过6 cm骨骼缺损的可行方法，尤其是在受区瘢痕化和无血管的病例或合并骨与软组织缺损的患者中。在创伤后1周内进行重建时结果最佳。
