Marchaland Jean-Pierre, Ollat Didier, Mathieu Laurent, Versier Gilbert
Hospital Chirurgie Orthopédique et Traumatologie, HIA Begin, 69 avenue de Paris, 94160, Saint Mandé, France.
Hospital Chirurgie Orthopédique et Traumatologie, HIA Begin, Saint Mandé, France.
Eur J Trauma Emerg Surg. 2009 Feb;35(1):3-9. doi: 10.1007/s00068-008-8142-5. Epub 2008 Dec 22.
In precarious conditions, bone exposure on the leg is synonymous with amputation. The authors describe their experiences with such injuries in 15 patients.
Fifteen patients were operated by the same surgeon in Afghanistan and Ivory Coast for bone exposure on the leg after war or roadcrash injuries. A flap was performed after an initial debridement and external fixation. The delay between the flap and the first injury was about 42 days.
The duration of hospitalization following the flap was about eight days. Cicatrization was complete after 25 days. Three patients had complications: one partial necrosis of the skin, one sepsis, and one patient had a leg amputation.
In precarious conditions, the management of bone exposure in local civilians and soldiers is limited by the conditions in their country or the conditions at the field hospital. The treatment must be simple and reliable because it may be difficult to perform patient follow-up. A pedicled flap provides new vascularized tissue with anti-infectious properties. Classical indications are: muscular flaps for the proximal and the middle part of the leg; sural flaps for the middle and the distal-third part. In substantial soft-tissue defects, amputation must be discussed.
The pedicled flap is an essential technique for fighting against infection, especially in cases where only poor technical and medicinal resources are available. This simple and reliable technique allows most tissue defects on the leg to be covered.
在不稳定的情况下，腿部骨外露意味着截肢。作者描述了他们对15例此类损伤患者的治疗经验。
15例患者在阿富汗和科特迪瓦由同一位外科医生进行手术，这些患者因战争或车祸伤导致腿部骨外露。在初次清创和外固定后进行皮瓣手术。皮瓣手术与初次受伤之间的间隔约为42天。
皮瓣手术后的住院时间约为8天。25天后瘢痕形成完成。3例患者出现并发症：1例皮肤部分坏死，1例发生脓毒症，1例患者接受了截肢手术。
在不稳定的情况下，当地平民和士兵腿部骨外露的治疗受到其所在国家的条件或野战医院条件的限制。治疗必须简单可靠，因为可能难以对患者进行随访。带蒂皮瓣可提供具有抗感染特性的新的血管化组织。经典的适应证为：用于小腿近端和中部的肌皮瓣；用于小腿中部和远侧三分之一部的腓肠皮瓣。在存在大量软组织缺损的情况下，必须考虑截肢。
带蒂皮瓣是抗感染的一项重要技术，尤其是在技术和医疗资源匮乏的情况下。这种简单可靠的技术能够覆盖小腿的大多数组织缺损。
