Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, University Hospital Graz, 8036 Graz, Austria.
Division of Hand and Microsurgery, Private Hospital Maria Hilf, 9020 Klagenfurt am Woerthersee, Austria.
Medicina (Kaunas). 2023 Jun 27;59(7):1206. doi: 10.3390/medicina59071206.
This case report focuses on a 17-year-old polytrauma patient who suffered a septic wound infection after an open reduction and internal fixation (ORIF) and soft tissue reconstruction with a pedicled flap, which led to a substantial bone and soft tissue defect of the lower leg. After thorough antibiotic treatment and after ensuring a non-septic wound, the defect was reconstructed using a contralateral free fibula flap designed as a flow through flap in a double loop manner to accommodate two fibular fragments and an ipsilateral ALT flap. Early weight bearing was initiated 11 days after the free flap transfer under external fixation, with full weight bearing achieved in 36 days with external fixation. After the removal of external fixation, full weight bearing was able to be reinitiated after 13 days, leading to the patient's return to normal activity 6 months after the bony reconstruction. This case presents an innovative approach to treating a complex defect, with the final decision on using two separate free flaps instead of a single osteofasciocutaneous free flap resulting in a good bony reconstruction and soft tissue coverage, and with the use of external fixation enabling early rehabilitation.
本病例报告重点介绍了一位 17 岁的多发创伤患者，他在接受切开复位内固定（ORIF）和带蒂皮瓣软组织重建后发生感染性伤口，导致小腿出现严重的骨和软组织缺损。经过彻底的抗生素治疗并确保伤口无感染后，采用对侧游离腓骨瓣设计成双环式的贯通皮瓣，以容纳两个腓骨碎片和同侧 ALT 皮瓣，对缺损进行了重建。游离皮瓣转移后 11 天在外固定下开始早期负重，36 天在外固定下完全负重。拆除外固定后，13 天后再次开始完全负重，导致患者在骨重建后 6 个月恢复正常活动。本病例提出了一种治疗复杂缺损的创新方法，最终决定使用两个独立的游离皮瓣而不是单个骨-筋膜皮瓣，从而实现了良好的骨重建和软组织覆盖，并且使用外固定可以实现早期康复。
