Kinzl L, Suger G, Stober R
Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie, Universität Ulm.
Unfallchirurg. 1996 Oct;99(10):714-26. doi: 10.1007/s001130050047.
In the past, the main emphasis in the treatment of complex limb injuries was placed upon the reconstruction of bony defects. Recently, however, reconstructive soft-tissue procedures have gained the attention they deserve. The salvage of a severely injured extremity depends rather on the feasibility of reconstructive surgical tissue procedures than on restoration of the bony defect. Sufficient vascularity is an essential condition for fracture healing and the prevention of post-traumatic complications like osteomyelitis and pseudarthrosis. If primary closure of a soft-tissue defect is not possible, preliminary covering has to be obtained with artificial skin replacement (vacuum sealing) until definitive covering with muscle or musculocutaneous flaps can be achieved. With the microvascular restorative techniques available today even complex soft-tissue problems can be solved. Nevertheless, an appropriate infrastructure and a trained and skilled surgeon are essential.
过去，复杂肢体损伤治疗的主要重点在于骨缺损的重建。然而，近来重建性软组织手术已获得了应有的关注。严重受伤肢体的挽救更多地取决于重建性外科组织手术的可行性，而非骨缺损的修复。充足的血供是骨折愈合以及预防骨髓炎和假关节等创伤后并发症的必要条件。如果无法对软组织缺损进行一期缝合，必须先用人工皮肤替代物（真空密封）进行初步覆盖，直至能用肌肉或肌皮瓣进行确定性覆盖。凭借如今可用的微血管修复技术，甚至复杂的软组织问题也能得到解决。尽管如此，合适的基础设施以及训练有素、技术娴熟的外科医生必不可少。
