Kim Youngwoo, Kong Chae Gwan, Park Ho Youn, Lee Kwan Soo, Sur Yoo Joon
Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Acta Orthop Traumatol Turc. 2023 Sep 22;57(6):366-71. doi: 10.5152/j.aott.2023.22104.
This study aimed to introduce a new wound management method combining negative pressure wound therapy and polymethylmethacrylate sealant for Gustilo type III open tibia fractures and to evaluate its clinical outcomes.
Among 186 patients who visited our institution for the treatment of open tibia fractures between January 2016 and December 2019, 20 male patients who sustained Gustilo type III open tibia fractures and were compelled to undergo delayed flap coverage using negative pressure wound therapy combined with polymethylmethacrylate sealant due to initial critical condition were enrolled in this study. We retrospectively investigated patients' demographics, interval between the injury and flap coverage, number of negative pressure wound therapy changes, flap survival, bone union time, and infection-induced complications.
The mean interval from injury until flap coverage was 27.8 (range, 8-63) days. Most soft-tissue defects were reconstructed using free flaps (14/20, 70%); the anterolateral thigh flap was the most frequently used flap (12/20, 60%) in this study. Among 20 flaps trans- ferred, 16 flaps (80%) survived uneventfully, 1 flap (5%) developed partial necrosis, and 3 flaps (15%) failed. The mean follow-up period was 22.7 (range, 12- 43) months. A total of 17 patients (85%) achieved tibia fracture union. The mean bone union time was 31 (range, 12-81) weeks. With regard to infection-induced complications, 3 patients (15%) developed osteomyelitis and no patient showed superficial surgical site infection.
Combination therapy using negative pressure wound therapy and polymethylmethacrylate sealant serves as a useful and reliable therapeutic strategy for wound management of Gustilo type III open tibia fractures, especially when delayed soft-tissue recon- struction is unavoidable. Corresponding author: Yoo Joon Sur yoojoon@catholic.ac.kr Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Level IV, Therapeutic Study.
本研究旨在介绍一种将负压伤口治疗与聚甲基丙烯酸甲酯密封剂相结合的新型伤口处理方法，用于治疗 Gustilo Ⅲ型开放性胫骨骨折，并评估其临床疗效。
在 2016 年 1 月至 2019 年 12 月期间到我院治疗开放性胫骨骨折的 186 例患者中，选取 20 例因初始病情危急而被迫接受负压伤口治疗联合聚甲基丙烯酸甲酯密封剂进行延迟皮瓣覆盖的 Gustilo Ⅲ型开放性胫骨骨折男性患者纳入本研究。我们回顾性调查了患者的人口统计学资料、受伤至皮瓣覆盖的间隔时间、负压伤口治疗更换次数、皮瓣存活情况、骨愈合时间以及感染引起的并发症。
从受伤到皮瓣覆盖的平均间隔时间为 27.8（范围 8 - 63）天。大多数软组织缺损采用游离皮瓣修复（14/20，70%）；股前外侧皮瓣是本研究中最常用的皮瓣（12/20，60%）。在转移的 20 个皮瓣中，16 个皮瓣（80%）顺利存活，1 个皮瓣（5%）发生部分坏死，3 个皮瓣（15%）失败。平均随访期为 22.7（范围 12 - 43）个月。共有 17 例患者（85%）实现胫骨骨折愈合。平均骨愈合时间为 31（范围 12 - 81）周。关于感染引起的并发症，3 例患者（15%）发生骨髓炎，无患者出现手术切口浅表感染。
负压伤口治疗与聚甲基丙烯酸甲酯密封剂联合治疗是 Gustilo Ⅲ型开放性胫骨骨折伤口处理的一种有用且可靠的治疗策略，尤其是在不可避免地需要延迟软组织重建时。通讯作者：柳俊硕 yoojoon@catholic.ac.kr 本期刊内容根据知识共享署名 - 非商业性使用 4.0 国际许可协议授权。
四级，治疗性研究。
