Outcomes of anterolateral thigh-free flaps and conversion from external to internal fixation with bone grafting in gustilo type IIIB open tibial fractures
Outcomes of anterolateral thigh-free flaps and conversion from external to internal fixation with bone grafting in gustilo type IIIB open tibial fractures
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DOI：
10.1002/micr.21970
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发表时间：
2012-09-01
期刊：
影响因子：
2.1
通讯作者：
Han, Chung Soo
中科院分区：
文献类型：
--
作者：
Lee, Jae Hoon;Chung, Duke Whan;Han, Chung Soo
本研究的目的是分析股前外侧（ALT）游离皮瓣的实用性和临床结局，以及从外固定转为钢板内固定和植骨治疗Gustilo IIIB型开放性胫骨骨折。共对21例患者进行了回顾性分析。平均随访时间为18个月，平均年龄为46.7岁。有18名男性和3名女性。从损伤到皮瓣覆盖的平均时间为11.6天。所用皮瓣的平均尺寸为15.3 x 8.2 cm。骨缺损平均2.26cm。5例出现节段性骨缺损，行骨转移或带血管腓骨移植。当皮瓣成功，骨折部位没有任何感染的证据，钢板内固定和植骨进行。皮瓣成活20例。20例皮瓣成功的患者中，2例发生骨髓炎，但20例患者在伤后平均8.6个月获得牢固的骨愈合，100%的患者挽救了下肢。在最后一次随访时，根据普诺等人开发的方法，9例患者的功能评估结果为优或良; 6例为一般; 6例为差。Gustilo IIIB型开放性胫骨骨折中，无ALT皮瓣覆盖软组织缺损被认为是治疗复合缺损的有用选择。此外，转换为内固定和植骨可以是一种替代方法，以减少并发症的风险和外固定器的不便。(c)2012 Wiley Periodicals，Inc.显微外科，2012年。
The purpose of this study was to analyze the utility and the clinical outcomes of anterolateral thigh (ALT)-free flaps and conversion from external to internal fixation with plating and bone grafting in Gustilo type IIIB open tibial fractures. A total of 21 patients were analyzed retrospectively. The mean follow-up period was 18 months and the mean age was 46.7 years. There were 18 men and three women. The mean time from injury to flap coverage was 11.6 days. The mean size of flaps used was 15.3 x 8.2 cm. The mean size of bone defects was 2.26 cm. Segmental bone defects were observed in 5 five cases, for which bone transport or vascularized fibular graft were performed. When flaps were successful and the fracture sites did not have any evidence of infection, internal fixation with plates and bone grafting were performed. Flaps survived in 20 cases. In the 20 cases with successful flaps, two cases developed osteomyelitis, but the 20 cases achieved solid bone union at a mean of 8.6 months after the injury, salvaging the lower extremity in 100% of the cases. At the last follow-up, 9 nine cases were measured excellent or good; 6, fair; and 6, poor in the functional assessment based on the method developed by Puno et al. ALT- free flaps to cover soft tissue defects in Gustilo type IIIB open tibial fractures are considered as useful option for the treatment of composite defects. In addition, conversion to internal fixation and bone grafting can be an alternative method in order to reduce the risk of complications and inconvenience of external fixators. (c) 2012 Wiley Periodicals, Inc. Microsurgery, 2012.