Orthopedic and Traumatology University Clinic, Clinical Center of Serbia, Serbia; Faculty of Medicine, University of Belgrade, Serbia.
Orthopedic and Traumatology University Clinic, Clinical Center of Serbia, Serbia; Faculty of Medicine, University of Belgrade, Serbia.
Injury. 2019 Dec;50 Suppl 5:S29-S31. doi: 10.1016/j.injury.2019.10.043. Epub 2019 Oct 23.
The treatment of severely injured extremities still presents a very difficult task for trauma orthopaedic surgeons. Despite improvements in technology and surgical/microsurgical techniques, sometimes a limb must be amputated, otherwise severe and potentially fatal complications may develop. There is a well-established belief that severe open fractures should be left open. However, Godina proved wound coverage in the first 72 h (after an injury) to be safe and to bring good final results. So early wound cover (no later than one week after an injury) with well vascularized free flaps became the gold standard. Yet for many patients (some of whom have serious health problems), operative treatment needs to be postponed when they arrive to specialized microsurgical departments for microsurgical reconstruction much later than one week after incurring an injury. As the definite wound cover period from one week to 3 months seems to be hazardous, especially due to the potential of infection, we developed a safe, original flap technique that prevents infection and covers important structures such as exposed bones, tendons, nerves and vessels. We named this technique the "close-open-close free flap technique". It enables difficult wound cover in any biological phase of the wound, by combining complete flap cover first, with the removal of stitches from one side of the flap after 6-12 h. This technique works very well for borderline cases as well; where even after a complete debridement, dead tissue still remains in the wound - making wound cover very dangerous. Closing completely severe open fractures with free (or pedicled) flaps and removing the stitches on one side after 6-12 h, enables orthopaedic surgeons to safely cover any kind of wound in any biological phase of the wound. Additional debridements, lavages and reconstructions can easily be performed under the flap and after the danger of a serious infection has disappeared, definitive wound closure can be carried out.
严重创伤肢体的治疗仍然是创伤骨科医生面临的一项非常艰巨的任务。尽管技术和手术/显微外科技术有所进步，但有时仍需要截肢，否则可能会出现严重且潜在致命的并发症。人们普遍认为严重的开放性骨折应保持开放性。然而，Godina 证明在受伤后 72 小时内（受伤后）进行伤口覆盖是安全的，并且可以带来良好的最终结果。因此，早期（受伤后不超过一周）用血流丰富的游离皮瓣进行早期伤口覆盖成为了金标准。然而，对于许多患者（其中一些患者存在严重的健康问题），当他们到达专门的显微外科部门接受显微重建治疗时，手术治疗需要推迟，因为他们在受伤后一周以上的时间才到达显微外科部门。由于从一周到三个月的明确伤口覆盖期似乎存在危险，尤其是由于感染的潜在风险，我们开发了一种安全、原创的皮瓣技术，可以防止感染，并覆盖重要的结构，如暴露的骨骼、肌腱、神经和血管。我们将这种技术命名为“闭合-开放-闭合游离皮瓣技术”。通过首先完全覆盖皮瓣，然后在皮瓣的一侧去除缝线，在 6-12 小时后，该技术可在任何伤口的生物学阶段进行困难的伤口覆盖，效果非常好。即使在完全清创后，伤口中仍存在坏死组织的边缘病例，这种情况也很危险，因此很难进行伤口覆盖。用游离（或带蒂）皮瓣完全闭合严重的开放性骨折，并在 6-12 小时后从皮瓣的一侧去除缝线，使骨科医生能够在伤口的任何生物学阶段安全覆盖任何类型的伤口。在皮瓣下可以轻松进行额外的清创、冲洗和重建，并且在严重感染的危险消失后，可以进行最终的伤口闭合。
