摘要目的 探讨足踝部创伤后严重复合组织缺损感染创面的治疗方法及疗效. 方法 回顾性分析2006年3月至2012年3月收治的120例足踝部创伤后严重复合组织缺损感染创面患者资料,男100例,女20例;年龄4 ～ 80岁,平均41.1岁.受伤至手术时间为1个月至3年.皮肤软组织缺损面积为3.0 cm×1.5 cm～23.0 cm×12.0 cm.单纯皮瓣修复创面20例,皮瓣+载抗生素可吸收人工骨(RBK)修复57例,皮瓣+RBK+自体髂骨植骨43例.先行清创、VSD技术治疗创面者108例,清创后直接皮瓣修复创面者12例.对骨折内固定失效仍需固定者改用外固定支架固定. 结果 120例患者术后获3个月至5年(平均15个月)随访.106例患者术后伤口一期愈合,14例患者二期愈合.6例患者皮瓣或肌皮瓣出现部分坏死,均为带蒂转位者.113例患者骨髓炎一期治愈,骨折愈合时间为4～8个月,平均5.2个月;3例出现骨不愈合患者再次行自体髂骨植骨,6～8个月后治愈;2例跟骨骨髓炎患者术后复发,经再次手术后状况良好;另有2例虽经皮瓣移植创面闭合,但仍残留窦道换药,需再次手术. 结论 对于足踝部创伤后严重复合组织缺损感染创面,根据不同伤情,应用VSD技术、RBK、皮瓣、肌皮瓣转位或移植技术可取得良好疗效.

abstractsObjective To evaluate the clinical outcomes of repairing infected composite tissue wounds at the ankle or foot using vacuum sealing drainage (VSD),OsteoSet Resorbable Mini-Bead Kit (RBK) implantation and skin or myocutaneous grafts. Methods Included in the present study were 120 patients with infected composite tissue wounds at the ankle or foot who had been treated in our department from March 2006 to March 2012.They were 100 males and 20 females,aged from 4 to 80 years (average,41.1 years).The time from injury to surgery ranged from one month to 3 years.The areas of soft tissue wound ranged from 3.0 cm × 1.5 cm to 23.0 cm × 12.0 cm.Twenty cases were treated with skin or myocutaneous flaps,57 cases with flaps plus RBK implantation,and 43 cases with flaps plus RBK plus autogenic iliac graft.Thorough debridement followed by VSD covering was used in 108 cases and thorough debridement followed by direct skin or myocutaneous grafting in 12 cases.If the internal fixation of ankle or foot fracture failed,external fixation was applied instead. Results All patients were followed up for 3 months to 5 years (average,15 months).Primary healing was achieved in 106 cases,and secondary healing in 14 cases.All the grafts survived well except 6 ones that had partial necrosis following pedicled transposition.Osteomyelitis was cured at one stage in 113 cases which obtained bone union after 4 to 8 months (average,5.2 months).Bone nonunion occurred in 3 cases which were cured with autogenic iliac graft after 6 to 8 months.Two cases of chronic calcaneal osteomyelitis experienced recurrence which was cured after secondary operation.Two other cases received secondary operation because of sinus tract formation after removal of drainage tube. Conclusion VSD,RBK implantation and skin or myocutaneous grafts are effective ways to treat infected composite tissue wounds at the ankle or foot.