Li Hong, Qin Yue, Wang Liquan, Tang Lin, Zhao Wenguang, Zhang Wenjia, Dou Haichuan
Department of Vascular Surgery, The First Hospital of Jilin University, Changchun, China.
Department of Gynaecology and Obstetrics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China.
SAGE Open Med Case Rep. 2020 Jun 22;8:2050313X20936078. doi: 10.1177/2050313X20936078. eCollection 2020.
Varicose ulcer, a severe symptom of chronic venous insufficiency, may be refractory to treatment when accompanied by bone exposure. The lack of a blood supply and fresh granulation tissue on the exposed bone can result in a protracted healing time. A 59-year-old man suffered from varicose veins for 10 years, a varicose ulcer for 1 year, and an exposed right tibia for 40 days after using traditional Chinese medicinal plasters. The patient was treated with conventional high ligation and stripping of the great saphenous vein, segmental endovenous laser ablation, bone drilling, and a free skin graft. Patient outcome is satisfactory 2 years after discharge. We present a rare case of varicose ulcer in association with bone exposure. Tibia drilling with Kirschner wire was used to allow blood flow and provide nutrients for the formation of granulation tissue over the exposed bone and wound healing. Subsequently, free skin grafting was used during reconstructive surgery to replace skin loss on the right calf. Physicians encountering this rare condition in clinical practice should consider our treatment approach as a successful limb-preserving option for these patients.
静脉曲张性溃疡是慢性静脉功能不全的严重症状，当伴有骨质外露时，治疗可能会很棘手。外露骨缺乏血液供应和新鲜肉芽组织会导致愈合时间延长。一名59岁男性患静脉曲张10年，静脉曲张性溃疡1年，使用中药膏药后右胫骨外露40天。该患者接受了大隐静脉传统高位结扎剥脱术、分段静脉腔内激光消融术、骨钻孔术和游离皮片移植术。出院2年后患者预后良好。我们报告一例罕见的伴有骨质外露的静脉曲张性溃疡病例。使用克氏针进行胫骨钻孔，以促进血流并为外露骨上肉芽组织的形成和伤口愈合提供营养。随后，在重建手术中采用游离皮片移植来替代右小腿的皮肤缺损。临床实践中遇到这种罕见情况的医生应将我们的治疗方法视为这些患者成功保肢的选择。
