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

doi:10.3969/j.issn.2095-4344.2014.18.023

Abstract

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

CLC Number:

R318

Liu Wei, Xiao Jun, Zheng Zuo-yong, Xiao Yan, Li Xiao-fei, Ou Guang-peng, Huang Rui-liang, Ahmatjiang•Yusufu. Vacuum sealing drainage combined with groin flap graft repairs soft tissue defects in the anterior tibia[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(18): 2921-2926.

Figures/Tables 3

2.1 参与者数量分析按意向性分析，纳入24例胫前大面积软组织缺损患者，根据治疗方案分为2组，负压封闭引流组及非负压封闭引流组各12例，全部进入结果分析，无脱落。 2.2 基线资料对比 2组患者在性别、年龄、软组织缺损面积、合并症、致伤原因等方面基本一致，差异均无显著性意义(P > 0.05，表1)。 2.3 住院时间、感染情况、创面及骨折愈合情况比较 2组修复前住院时间及皮瓣面积比较，差异有显著性意义(P < 0.05)；修复后住院时间、总住院时间比较，差异均无显著性意义(P > 0.05)。负压封闭引流治疗后创面感染率为0，非负压封闭引流组常规抗感染治疗8-14 d后创面感染率为75%(表2)。随访过程中骨折愈合时间非负压封闭引流组10-24 (8.5±3.85)个月；负压封闭引流组6-18(5.5±2.45)个月，差异有显著性意义。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，提高手术成功率，最大限度恢复患肢功能。治疗后未出现静脉危象，所有皮瓣成活，治疗后随访1年，皮瓣质地柔韧，外观良好，活动功能良好，患肢功能恢复满意。 2.4 典型病例男，37岁，车祸碾压伤后右小腿疼痛、流血、活动受限。入院后急诊清创，行负压封闭引流护创软组织缺损区，二期取旋髂浅动脉的髂腹股沟皮瓣修复，皮瓣面积为 12 cm×20 cm，在小腿内侧切开寻找受区血管，腓肠肌内侧头有一膝下内侧动脉及大隐静脉的2条属支表浅静脉与旋髂浅动脉及伴行静脉吻合游离皮瓣修复胫前大面积软组织缺损(图1)。 2.5 不良事件皮瓣修复后负压封闭引流组1例、非负压封闭引流组2例皮瓣出现皮缘部分坏死，清创植皮或直接缝合后创面愈合良好；其余皮瓣全部成活，创面Ⅰ期愈合。"

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