Free Tissue Transfer with Distraction Osteogenesis Is Effective for Limb Salvage of the Infected Traumatized Lower Extremity
Free Tissue Transfer with Distraction Osteogenesis Is Effective for Limb Salvage of the Infected Traumatized Lower Extremity
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DOI：
10.1097/prs.0b013e318213a141
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发表时间：
2011-06-01
影响因子：
3.6
通讯作者：
Kaufman, Bram R.
中科院分区：
文献类型：
--
作者：
Chim, Harvey;Sontich, John K.;Kaufman, Bram R.
背景：下肢急性和慢性胫骨骨皮肤缺损的修复是一个棘手的问题。虽然局部、远端和游离组织转移或单纯植骨可能足以修复小伤口或骨缺损，但较大或复杂的缺损需要不同的方法。作者介绍了他们的经验，结合牵引成骨的复杂复合骨deficiency.Methods：作者回顾了一系列的28例患者进行治疗超过8年的时间，随访范围从1到8.5年。伤后平均皮瓣时间为1082天（范围，6天至30年）。治疗适应症包括胫骨感染性骨不连（n = 18），急性创伤性骨丢失（n = 5），牵引成骨过程中发生的皮肤和软组织破裂（n = 4），以及先前失败的游离皮瓣后暴露的骨（n = 1）。游离腹直肌皮瓣17例，背阔肌皮瓣5例，股薄肌皮瓣5例，前臂桡侧皮瓣1例。骨间隙的平均长度为63 mm（范围：30 - 140 mm），需要皮瓣覆盖的平均伤口面积为219 cm（2）（范围：35 - 400 cm（2））。25名患者（89.3%）成功完成皮瓣覆盖，并继续独立行走和重返工作岗位。轻微并发症发生率为42.9%.Conclusions：牵张成骨结合游离组织转移是一种强大的技术，可以保肢，特别是当局部和区域皮瓣不可用或不足。对于胫骨感染性骨不连，它允许采用分期手术，使潜在的骨髓炎得以暴露，并提供血管化的健康软组织覆盖，便于重复手术进行牵引。（Plast。重建127：2364，2011）。
Background: Salvage of acute and chronic tibial osseocutaneous defects in the lower extremity poses a formidable problem. Although local, distant, and free tissue transfer or bone grafting alone may be adequate for repair of small wounds or osseous defects, large or complicated defects necessitate a different approach. The authors describe their experience with free tissue transfer in combination with distraction osteogenesis for complex composite osteocutaneous defects.Methods: The authors reviewed a consecutive series of 28 patients who underwent treatment over an 8-year period, with follow-up ranging from 1 to 8.5 years. Mean time to flap after injury was 1082 days (range, 6 days to 30 years). Indications for treatment included infected nonunion of the tibia (n = 18), acute traumatic bone loss (n = 5), skin and soft-tissue breakdown that occurred during distraction osteogenesis (n = 4), and exposed bone following previous failed free flap (n = 1).Results: Free flaps used included the rectus abdominis (n = 17), latissimus dorsi (n = 5), gracilis (n = 5), and radial forearm (n = 1). Mean length of bone gap was 63 mm (range, 30 to 140 mm), and mean area of wound requiring flap coverage was 219 cm(2) (range, 35 to 400 cm(2)). Twenty-five patients (89.3 percent) had successful flap coverage and went on to ambulate independently and return to work. The minor complication rate was 42.9 percent.Conclusions: Distraction osteogenesis in combination with free tissue transfer is a powerful technique that allows limb salvage, particularly when local and regional flaps are unavailable or inadequate. For infected nonunion of the tibia, it permits a staged approach that allows underlying osteomyelitis to declare itself and provides vascularized healthy soft-tissue coverage that facilitates repeated operations for the purpose of distraction. (Plast. Reconstr. Surg. 127: 2364, 2011.)