Irons G B, Wood M B
Mayo Clin Proc. 1986 May;61(5):382-7. doi: 10.1016/s0025-6196(12)61958-2.
For treatment of chronic osteomyelitic wounds of the lower part of the leg, a three-stage approach is necessary: (1) adequate debridement of bone and soft tissue, (2) control of infection by open packing with frequent dressing changes and use of intravenously administered antibiotics, and (3) healthy soft-tissue coverage and obliteration of dead space. If the bone is unstable, it can be immobilized temporarily by means of external fixation. Bone grafting can be accomplished by use of conventional bone grafting after healing of the soft tissues, a vascularized bone graft, or open bone grafting. Soft-tissue coverage is provided by a local muscle flap or a free muscle flap. We prefer to cover the muscle with a skin graft. The muscle flaps described in this article obliterate dead space, provide soft-tissue coverage, act as a bed for skin grafts, and improve the vascularity of the wound.
对于小腿下部慢性骨髓炎伤口的治疗，需要采用三阶段方法：（1）对骨和软组织进行充分清创；（2）通过开放填塞、频繁更换敷料以及使用静脉注射抗生素来控制感染；（3）用健康的软组织覆盖并消除死腔。如果骨骼不稳定，可通过外固定进行临时固定。软组织愈合后，可采用传统骨移植、带血管蒂骨移植或开放骨移植来完成骨移植。局部肌皮瓣或游离肌皮瓣可用于提供软组织覆盖。我们更倾向于用皮片覆盖肌肉。本文所述的肌皮瓣可消除死腔、提供软组织覆盖、作为皮片移植的床并改善伤口的血运。
