双向吸引VSD结合皮瓣移植治疗感染性骨外露

摘要

Objective To explore the effect of two-way Vacuum Sealing Drainage (VSD) and skin flap transplantation on the treatment of infectious bone exposure.Method After 23 cases of infectious bone exposure were lavaged by twoway VSD for 7～21 d flap transplantation were adopted to repair soft tissue lesion with 8 cases through fascial pedicle skin flap and 12 cases through nutrient vessel skin flap in which 7 cases through sural nerve nutrition blood supply flaps,3 cases through saphenous nerve nutrition vascular flap,3 cases through superficial peroneal neurocutaneous vascular flap;3 cases through anterolateral thigh flap.Traditional one-way VSDs were used in 33 cases as control group.Result Waiting time for flap repair,frequency which VSDs were used,hospital days and expenses were less in two way VSD group than in control group (P ＜ 0.01).All flaps survived,with Ⅰ phase of wound healing in 13 case and,Ⅱ phase in 10 cases.Fractures were healed in 11 cases within 3～6 months and 5 cases within 9～12 months.3 cases with nonunions were healed by autologous iliac bone graft after the flap survived one year later.No infection recurrences of bone were found in the follow-ups of 2～3 years.Conclusion It is an effective and feasible method that two-way VSD combined with skin flap was used in the treatment of infectious bone exposure.It can shorten pahtogenesis and reduce expenses.%目的 探讨双向吸引负压封闭引流技术(Vacuum Sealing Drainage,VSD)结合皮瓣移植治疗感染性骨外露患者的疗效.方法 23例感染性骨外露患者用双向吸引VSD灌吸7～21d后行皮瓣移植:采用筋膜皮瓣修复8例；皮神经营养皮瓣12例,其中腓肠神经营养血供皮瓣修复7例,隐神经营养血管皮瓣3例(1例采用双皮瓣修复),腓浅神经营养血管皮瓣3例；游离股前外侧皮瓣3例.对照组33例以传统单向VSD覆盖处理.比较两组的等待皮瓣修复天数、VSD使用频次、住院天数及费用.结果 采用改良双向吸引VSD组的等待皮瓣修复天数、VSD使用频次、住院天数及费用均少于对照组(P＜0.01).23例皮瓣全部成活,伤口Ⅰ期愈合13例,Ⅱ期愈合10例.其中骨折患者共19例,11例患者骨折3～6m全部愈合,5例患者9～12m愈合,3例患者骨不连,皮瓣愈合后1y,行自体髂骨植骨愈合.骨感染经2～3y随访无复发.结论 双向VSD结合皮瓣修复治疗感染性骨外露可显著缩短病程,减低费用,是有效、可行的方法.