Gao Yuling, Liu Yang, Hu Hongyu, Gao Shunhong, Zhou Junlin
Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
Department of Hand Surgery, The Second Hospital of Tangshan, Tangshan, Hebei, 063000, China.
Open Med (Wars). 2024 Sep 20;19(1):20241038. doi: 10.1515/med-2024-1038. eCollection 2024.
Gustilo IIIB/C injuries are common for tibia diaphysis fractures with high rates of nonunion, osteomyelitis, and amputation. However, the managements on tibial Gustilo IIIB/C injuries are still controversial and individual. The aim of this study is to introduce the tibial periosteum flap combined with autologous bone grafting to treat Gustilo-IIIB/IIIC injuries.
Sixteen Gustilo type IIIB/C tibial fracture patients who underwent tibial periosteum flaps with autologous bone grafting surgeries were retrospectively studied. In the first stage, the wound was treated with debridement and the fracture was reduced and fixed with an external fixator. After covering with vacuum sealing drainage for 7 days, the wound areas were repaired by flaps. When the flaps survived and external fixators were removed, the tibial periosteum flaps were taken with autologous bone grafting for bone defects.
The tibia fractures were comminuted fractures with mean size of segment bone defects 3.1 ± 1.3 cm. All the flaps survived and the wound healed in the first stage after an average of 1.5 ± 0.6 months. The mean size of the flap was 13.2 ± 2.8 cm × 7.3 ± 3.1 cm. All the autografts healed in 4.5 ± 0.7 months without infection and malunion. There was no pain in the affected limb. The weight-bearing and walking function were restored.
Tibial periosteum flap combined with autologous bone grafting is effective to treat bone-skin defect of leg with Gustilo-IIIB/IIIC injury.
Gustilo IIIB/C型损伤在胫骨干骨折中很常见，骨不连、骨髓炎和截肢发生率高。然而，对于胫骨Gustilo IIIB/C型损伤的治疗仍存在争议且因人而异。本研究的目的是介绍胫骨骨膜瓣联合自体骨移植治疗Gustilo-IIIB/IIIC型损伤。
回顾性研究16例接受胫骨骨膜瓣联合自体骨移植手术的Gustilo IIIB/C型胫骨骨折患者。第一阶段，对伤口进行清创处理，骨折复位并用外固定器固定。覆盖负压封闭引流7天后，用皮瓣修复伤口区域。当皮瓣存活且拆除外固定器后，取胫骨骨膜瓣并联合自体骨移植治疗骨缺损。
胫骨骨折为粉碎性骨折，节段性骨缺损平均大小为3.1±1.3 cm。所有皮瓣均存活，伤口在平均1.5±0.6个月后一期愈合。皮瓣平均大小为13.2±2.8 cm×7.3±3.1 cm。所有自体骨移植均在4.5±0.7个月愈合，无感染和畸形愈合。患肢无疼痛。负重和行走功能得以恢复。
胫骨骨膜瓣联合自体骨移植治疗伴有Gustilo-IIIB/IIIC型损伤的小腿骨皮肤缺损有效。
