皮瓣移植结合骨牵张技术修复感染性胫骨复合皮肤组织缺损的临床效果观察

目的：观察皮瓣移植结合骨牵张技术修复感染性胫骨复合皮肤组织缺损的临床效果。方法：自2008年6月至2012年6月，共收治了胫骨感染性复合组织缺损16例，采用一期彻底去除病变坏死组织和病变的胫骨断端，切取同侧腓肠肌皮瓣、腓肠神经营养血管皮瓣转位、对侧小腿内侧皮瓣和游离皮瓣移植修复小腿皮肤缺损，二期行骨牵张延长术进行治疗。结果：所有16例胫骨复合组织缺损病例感染均得到了控制，移植的皮瓣顺利成活，胫骨截骨延长区成骨良好，断端骨愈合，其中2例出现针道感染，无血管神经并发症发生。骨延长2～9cm，平均延长5．5cm。外同定延长支架在停止骨延长8-20个月后拆除，双下肢等长，膝关节和踝关节功能良好。术后细菌培养＋药敏结果：金黄色葡萄球菌感染8例，表皮葡萄球菌感染4例，大肠杆菌感染1例，阴沟肠杆菌感染l例，肠球菌感染l例。结论：伤口彻底清创，胫骨断端坏死骨切除后一期行皮瓣移植，二期行骨牵张延长术是一种治疗感染性胫骨复合组织缺损的有效方法。

Effects of Skin Flap Transplantation Combined with Distraction Osteogenesis in Repairing of Bone Defects Along with Skin Tissue Defects Caused by Infection

Objective： To observe the effects of skin flap transplantation combined with distraction osteogenesis on repairing bone defects and skin tissue defects caused by infection. Methods： Between June 2008 and June 2012, 16 cases of bone defects along with skin tissue defects caused by infection were treated by using complete debridement, skin flap transplantation and distraction osteogenesis. Results： The infection of 16 cases of bone defects along with skin tissue defects were under control, and transplanted flaps survived successfully, without vascular and neurological complications. The Bone has healed well, including 2 cases of needle infections. Bone lengthening was between 2 em and 9 cm （average 5.5 cm）. Postoperative bacterial culture and sensitivity results： eight Staphylococcus aureus infection cases, four cases of Staphylococcus epidermidis infections, one E. coli infection case, one Enterobacter cloacae infection case, and one enterococci infection case. Conclusion： Using complete debridement, skin flap transplantation and distraction osteogenesis was an effective treatment for repairing of bone defects along with skin tissue defects caused by infection.