| Background:In recent years, with the rapid development of economy and society, serious accidents and injuries caused by high-energy injuries have increased dramatically, which accounts for more than foot fractures ankle fractures by39%of the total number of cases, and showed an increasing trend. Foot ankle fractures are the most common intra-articular fracture, foot ankle soft tissue thin, blood vessels, nerves and bone tissue superficial, postoperative infection, wound bone, tendons and nerves and blood vessels exposed more common, and deal with difficult, long course of treatment, easy complicated by deep tissue infections, severe enough to affect the function and aesthetics ankle Ministry. Flap is a common method of wound repair defects. With the recent lower extremity arterial anatomy and wear research and clinical application of flap flap microcirculation, combined with VSD technology, offers a variety of foot ankle repaired reliable method of complex wounds. This less invasive, faster recovery, the effect is obvious way to get a more clinical applications.Objective:To investigate pedicle flap surgery combined effect of vacuum sealing drainage repair ankle bone exposed and infected wounds in, choose a different flap according to the site of injury, seek reliable, better treatment of complex wounds simple sum severe bone bare foot and ankle trauma and clinical experience in the treatment of infected wounds.Methods:A retrospective from February2011to December2013, the application of pedicle flap combined with VSD3fixes eight cases of foot and ankle bare infected wounds and surgical pictures clinical data of patients aged35to58years (mean46±0.5) years, male25, female13cases. The causes of injury:crush injuries eight cases, seven cases of machine twisting injury, car accident injuries15cases,8cases of falls injury. Sites are located in the foot and ankle injuries, are associated with serious fractures, skin and soft tissue injuries range15.0cm×10.0cm～33.0cm×19.0cm, bone defects range3.0cm×2.5cm～4.0cm×4.5cm, accompanied by shin the first five cases of vascular injury, superficial peroneal nerve injury in4cases,2cases of deep peroneal nerve injury, posterior tibial vascular injury in3cases. According to the case flap survival and complications of the flap is divided into three categories:totally survived flaps, flap necrosis, skin edge necrosis or wound dehiscence flap. Results:38cases of flaps in37cases survived, one case of a large part of the skin flap necrosis in patients with poor glycemic control and, at the pedicle tunnel entrapment did not discover the survival rate of98.3%related to the strict control of blood glucose, the use of cross-After re-leg flap repair wound healing.3cases of partial skin flap necrosis, skin graft healed after dressing;1case of venous vascular crisis, survived after the rescue. The rest of homogeneous tissue flap survival, infection, fracture defect healed. Healing time (26±10) d. Defects were normal fracture healing, the healing time of6to10months, the average (7±0.8) months. Survival rate of107.4%.29cases were followed up for6-12months to obtain, nine cases were lost.13cases of flap slightly bloated appearance, skin color is different from the affected area, flap appearance and good elasticity, some shallow sensory recovery, after six months, subcutaneous fat atrophy, shape significantly improved after1year and returned to normal sensation, walking function well.15cases of non-bloated flaps, skin texture, skin color close proximity, deep feeling partially restored.1case edge healing, as the heel flap of skin flap crawl scar.Conclusion:The combination of pedicle flap surgery VSD can once completed bone and soft tissue infections defect repair, design flexibility, simple cut, in good shape for the bare ankle bone and the treatment of infected wounds opened up new avenues. |
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