Shen Yuming, Chen Hui, Hu Xiaohua, Huang Lei, Ma Chunxu
Department of Burns, Beijing Jishuitan Hospital, Beijing, 100035,
Department of Burns, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Feb 15;31(2):160-164. doi: 10.7507/1002-1892.201609117.
To investigate the effectiveness of tissue flap grafting and sequential bone lengthening for repairing severe soft tissue and bone defects of the lower extremity after burn injury.
Between January 2010 and December 2015, 11 cases of large segmental bone and soft tissue defects in the leg were treated. There were 10 males and 1 female, with a mean age of 28 years (range, 19-37 years). The causes included traffic accident in 8 cases, high voltage electric burn in 2 cases, CO poisoning burn in 1 case. The time from injury to admission was 3-14 days (mean, 6.5 days). The bone defect length was 8-18 cm (mean,14 cm); the skin soft tissue defect ranged from 13 cm × 8 cm to 25 cm × 19 cm. After complete removal of necrotic tissue and lesions of the femur or the tibia, the tissue flaps were used to repair soft tissue defect of the lower extremity in one-stage operation; bone defect was treated by Orthofix single side external fixation or Ilizarov ring external fixation in two-stage operation.
Eleven flaps survived completely, primary healing of incision was obtained in the others except for 1 patient who had necrotic bone infection, which was cured after removing necrosed femoral bone and filling with antibiotic bone cement spacer. During bone lengthening, pin tract infection occurred in 1 patient, and infection was controlled after dressing change. Bone lengthening ranged from 8 to 18 cm, with an average of 14 cm. After prolonged extension, the external fixator was retained for 4-12 months (mean, 6.5 months). All bone defects were repaired with bone healing time of 12-22 months (mean, 17 months). All patients were followed up 8-24 months (mean, 15 months). No vascular and neurological complication occurred during operation; no osteomyelitis or re-fracture occurred after operation, and the recovery of the lower extremity function was good.
Tissue flap grafting combined with bone lengthening is an effective method to repair severe bone and soft tissue defects of lower extremity.
探讨组织瓣移植联合序贯骨延长术修复烧伤后下肢严重软组织及骨缺损的疗效。
选取2010年1月至2015年12月间收治的11例小腿大段骨与软组织缺损患者。其中男性10例，女性1例，平均年龄28岁（19 - 37岁）。致伤原因：交通事故8例，高压电烧伤2例，一氧化碳中毒烧伤1例。受伤至入院时间为3 - 14天（平均6.5天）。骨缺损长度为8 - 18 cm（平均14 cm）；皮肤软组织缺损范围为13 cm×8 cm至25 cm×19 cm。彻底清除股骨或胫骨坏死组织及病灶后，一期采用组织瓣修复下肢软组织缺损；二期采用Orthofix单边外固定或Ilizarov环形外固定治疗骨缺损。
11块组织瓣全部存活，除1例发生坏死骨感染，经清除坏死股骨、植入抗生素骨水泥间隔物后治愈外，其余切口均一期愈合。骨延长过程中，1例患者发生针道感染，经换药后感染得到控制。骨延长长度为8 - 18 cm，平均14 cm。延长结束后，外固定架保留4 - 12个月（平均6.5个月）。所有骨缺损均获修复，骨愈合时间为12 - 22个月（平均17个月）。所有患者随访8 - 24个月（平均15个月）。术中无血管、神经并发症发生；术后无骨髓炎及再骨折发生，下肢功能恢复良好。
组织瓣移植联合骨延长术是修复下肢严重骨与软组织缺损的有效方法。
