Najean D, Tropet Y, Brientini J M, Vichard P
Service de Chirurgie Orthopédique Traumatologique et Plastique, CHU Besançon, Hôpital Jean Minjoz.
Ann Chir Plast Esthet. 1994 Aug;39(4):473-9; discussion 480-1.
The authors present 24 emergency covering procedures for 24 open leg fractures: 6 free flaps and 18 pedicled flaps. The procedure was selected according to the site dimensions and topography of the defect. Topographically, the division of the leg into 3 zones: middle, upper and lower seems to be some what artificial because in practice the junction between the middle and lower segments is still a source of error in the choice of the local flap which can be used. It is preferable to use pedicled flaps in the proximal half of the tibia and free flaps in the distal half. Many failures were observed with the use of fascio-cutaneous flaps. 18 of 24 fractures were internally fixed, which allowed emergency covering. In fact, although bony covering can wait 48 hours, the presence of osteosynthesis material means that covering must be performed at the same time. This makes the plastic and microsurgical procedures easier and ensures greater patient comfort during the consolidation period and rehabilitation. The authors present their results according to the method of soft tissue coverage, their reliability, the type of osteosynthesis, the complications, number of operations and time to bony consolidation. Encouraged by their results, the authors continue with this approach.
作者介绍了24种用于24例开放性小腿骨折的急诊覆盖手术方法：6种游离皮瓣和18种带蒂皮瓣。根据缺损部位的大小和局部解剖情况选择手术方法。从局部解剖学角度看，将小腿分为中、上、下三个区域似乎有些人为因素，因为在实际操作中，中下段交界处仍是选择可使用的局部皮瓣时的误差来源。胫骨近端一半宜使用带蒂皮瓣，远端一半宜使用游离皮瓣。使用筋膜皮瓣时观察到许多失败案例。24例骨折中有18例进行了内固定，这使得急诊覆盖成为可能。实际上，虽然骨覆盖可以等待48小时，但存在骨固定材料意味着必须同时进行覆盖。这使得整形和显微外科手术更容易，并确保患者在骨折愈合期和康复过程中更加舒适。作者根据软组织覆盖方法、其可靠性、骨固定类型、并发症、手术次数和骨愈合时间展示了他们的结果。受这些结果的鼓舞，作者继续采用这种方法。
