中国组织工程研究

中国组织工程研究 ›› 2014, Vol. 18 ›› Issue (18): 2921-2926.doi: 10.3969/j.issn.2095-4344.2014.18.023

• 器官移植临床实践 clinical practice of organ transplantation • 上一篇    下一篇

腹股沟皮瓣游离移植联合负压封闭引流修复胫前大面积软组织缺损

刘  伟1，肖  军1，郑佐勇1，肖  艳1，李晓菲1，区广鹏1，黄瑞良1，艾合买提江•玉素甫2   

  1. 1广东医学院附属高明医院骨一科，广东省佛山市  528500；2新疆医科大学第一附属医院骨科中心，新疆维吾尔自治区乌鲁木齐市  835200
  • 收稿日期:2014-02-10 出版日期:2014-04-30 发布日期:2014-04-30
  • 作者简介:刘伟，男，硕士，副主任医师，主要从事创伤、修复重建研究。
  • 基金资助:

    佛山市医学类科技攻关项目(201108288)

Vacuum sealing drainage combined with groin flap graft repairs soft tissue defects in the anterior tibia

Liu Wei1, Xiao Jun1, Zheng Zuo-yong1, Xiao Yan1, Li Xiao-fei1, Ou Guang-peng1, Huang Rui-liang1, Ahmatjiang•Yusufu2   

  1. 1First Department of Orthopedics, Gaoming Hospital Affiliated to Guangdong Medical College, Foshan 528500, Guangdong Province, China; 2Orthopedic Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 835200, Xinjiang Uygur Autonomous Region,    China
  • Received:2014-02-10 Online:2014-04-30 Published:2014-04-30
  • About author:Liu Wei, Master, Associate chief physician, First Department of Orthopedics, Gaoming Hospital Affiliated to Guangdong Medical College, Foshan 528500, Guangdong Province, China
  • Supported by:

    the Science and Technology Program for Medical Sciences of Foshan City, No. 201108288

PDF

717

被引次数

21

摘要：

背景：合并严重软组织并骨缺损的下肢开放性骨折，伤后胫前皮肤软组织坏死缺损，骨质、钢板外露等在临床上经常发生，关键在于坚强的骨折固定以及合理应用血供可靠的皮瓣封闭创面。
目的：探讨负压封闭引流联合腹股沟游离皮瓣修复胫前大面积软组织缺损的效果。
方法：纳入胫前大面积软组织缺损患者24例，根据修复方案分为2组，各12例。负压封闭引流组软组织缺损范围10 cm×15 cm-15 cm×20 cm。经清创后，外固定支架固定骨折，使用负压封闭引流敷料覆盖创面，三通管接生理盐水随时冲洗血块，7-10 d去除负压封闭引流负压，根据肉芽组织生长情况给予二期缝合，行旋髂浅动脉的髂腹股沟游离皮瓣与膝下内侧动静脉吻合移植修复。非负压封闭引流组创面大小10 cm×15 cm- 30 cm×20 cm，受伤至入院时间1-24 h。普通清创换药，二期固定或者皮瓣转移。
结果与结论：修复前住院时间及皮瓣面积比较，负压封闭引流组显著优于非负压封闭引流组(P < 0.05)；2组修复术后住院时间、总住院时间差异均无显著性意义(P > 0.05)。负压封闭引流组修复治疗后创面感染率为0，非负压封闭引流组治疗8-14 d后创面感染率为75%。2组创面及供区切口均Ⅰ期愈合，植皮顺利成活。2组患者均获随访，随访时间6-36个月，随访过程中非负压封闭引流组骨折愈合时间显著长于负压封闭引流组。2组皮瓣与周围皮肤色泽、质地相似，皮瓣受力处无血管危象的发生，无破溃，无臃肿。提示负压封闭引流联合腹股沟游离皮瓣修复对及时控制创伤后大面积软组织缺损感染，改善创面血运，缩短术前准备时间，及早闭合创面，促进创面及骨折愈合有显著作用，皮瓣质地柔韧，外观良好，活动功能良好，可明显缩短疗程，最大限度恢复患肢功能



中国组织工程研究杂志出版内容重点：肾移植；肝移植；移植；心脏移植；组织移植；皮肤移植；皮瓣移植；血管移植；器官移植；组织工程


全文链接：

关键词: 实验动物, 组织构建, 负压封闭引流, 腹股沟皮瓣, 游离移植, 大面积软组织缺损

Abstract:

BACKGROUND: Open fracture of lower limb with severe soft tissue and bone defects also accompanies anterior tibial soft tissue defects and exposure of sclerotin and steel plate, which can be crucially treated with strong fixation and use of skin flap to block the wound.
OBJECTIVE: To explore the clinical efficacy of a large area of soft tissue defects in the anterior tibia using vacuum sealing drainage combined with groin free flap.
METHODS: A total of 24 patients with a large area of soft tissue defects in the anterior tibia were included in this study and then divided into two groups, with 12 cases in each group. In vacuum sealing drainage group, the scope of soft tissue defects was ranged from 10 cm×15 cm to 15 cm×20 cm. After the debridement, the  fracture was fixed with external fixation scaffold and the wound was covered with the vacuum sealing drainage dressing. The blood clot was rinsed with normal saline via T-tube, and 7-10 days later the vacuum sealing drainage was given. According to the growth of granulation tissue, the wound was secondarily sutured, followed by groin free skin flap of superficial iliac circumflex artery with medial knee arteriovenous anastomosis transplantation. In the non-vacuum sealing drainage group, the wound size was ranged from 10 cm×5 cm to 30 cm×20 cm, the period from injury to admission was 1-24 hours. They were given conventional debridement and secondary fixation or skin flap transplantation.
RESULTS AND CONCLUSION: The length of preoperative hospital stay and the skin flap are in vacuum sealing drainage group were significantly better than those in non-vacuum sealing drainage group (P < 0.05). There was no significant difference in the length of postoperative stay and total length of hospital stay between the two groups (P > 0.05). The wound infection rate was 0 in vacuum sealing drainage group and 75% in non-vacuum sealing drainage group at 8-14 days after treatment. The wound and donor area incision were healed at I stage, the skin grafts survived. All the involved patients in two groups were followed up, for 6-36 months. During the follow-up process, the fracture healing time in non-vacuum sealing drainage group was significantly longer than that in vacuum sealing drainage group. The skin flap in two groups was similar to surrounding skin in color and texture, the flap exhibited no vessels, no ulceration, and no clumsy. The vacuum sealing drainage combined with groin free flap can timely control a large area of soft tissue defects post-trauma, improve wound blood supply, shorten preoperative preparation time, early close the wound, significantly promote the healing of wound and fracture. The skin flap is soft, flexible, well-looking, and active functional, it significantly shortens the course of treatment and maximizes the recovery of limb function.



中国组织工程研究杂志出版内容重点：肾移植；肝移植；移植；心脏移植；组织移植；皮肤移植；皮瓣移植；血管移植；器官移植；组织工程


全文链接：

Key words: drainage, groin, surgical groin, tissue transplantation, soft tissue defects

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