CAJ | 학술논문

目的探讨外固定器在前臂复合组织缺损皮瓣修复重建中的应用价值.方法 2005年5月至2008年12月,共收治创伤所致前臂复合组织缺损,且联合应用外固定器行皮瓣修复治疗的患者17例,其中男性11例,女性6例;年龄19～47岁,平均25.6岁.所有病例均有深部肌腱、骨骼外露.皮肤缺损面积7 cm×4 cm～19 cm ×9 cm,全部采用带蒂皮瓣移植修复,皮瓣面积10 cm×6 cm～20 cm × 15 cm.带蒂皮瓣蒂端缝合成管状,应用外固定器保持蒂部位置.固定针分别位于尺骨和髂骨者5例,位于桡骨和髂骨者12例.固定时间3～8周,平均5.1周.结果所有患者均获随访,随访时间3～20个月,平均11.3个月.带蒂皮瓣全部成活,无压疮、腋窝糜烂、筋膜间隔综合征及骨髓炎等发生.术后4～6周断蒂,1例断蒂端存在表浅感染,经换药后创面愈合,其余16例断蒂后创面顺利愈合.骨折愈合时间8.5～15周,平均13.5周.二期皮瓣整形与功能重建者11例次.所有患者手及前臂功能恢复满意,感觉恢复至S3～S4级(1954年英国医学研究会感觉恢复分级标准),手外在肌和腕部肌肉肌力约Ⅳ～Ⅴ级.11例返回原工作岗位,6例满足日常生活需要.结论在前臂复合组织缺损带蒂皮瓣修复中,应用外固定器可稳定地保持蒂部位置,代替石膏贴胸位固定,减少皮瓣血管痉挛的发生,便于皮瓣观察、护理和换药,利于前臂各关节主动及被动活动,最大程度恢复肢体功能.
목적 탐토외고정기재전비복합조직결손피판수복중건중적응용개치.방법 2005년5월지2008년12월,공수치창상소치전비복합조직결손,차연합응용외고정기행피판수복치료적환자17례,기중남성11례,녀성6례;년령19～47세,평균25.6세.소유병례균유심부기건、골격외로.피부결손면적7 cm×4 cm～19 cm ×9 cm,전부채용대체피판이식수복,피판면적10 cm×6 cm～20 cm × 15 cm.대체피판체단봉합성관상,응용외고정기보지체부위치.고정침분별위우척골화가골자5례,위우뇨골화가골자12례.고정시간3～8주,평균5.1주.결과 소유환자균획수방,수방시간3～20개월,평균11.3개월.대체피판전부성활,무압창、액와미란、근막간격종합정급골수염등발생.술후4～6주단체,1례단체단존재표천감염,경환약후창면유합,기여16례단체후창면순리유합.골절유합시간8.5～15주,평균13.5주.이기피판정형여공능중건자11례차.소유환자수급전비공능회복만의,감각회복지S3～S4급(1954년영국의학연구회감각회복분급표준),수외재기화완부기육기력약Ⅳ～Ⅴ급.11례반회원공작강위,6례만족일상생활수요.결론 재전비복합조직결손대체피판수복중,응용외고정기가은정지보지체부위치,대체석고첩흉위고정,감소피판혈관경련적발생,편우피판관찰、호리화환약,리우전비각관절주동급피동활동,최대정도회복지체공능.
Objective To discuss the curative effect of the external fixator for complex tissue defect in the forearm. Methods From May, 2005 through December, 2008, the external fixtors were used in 17 patients to treat the complex tissue defect in the forearm caused by trauma. There were 11 male and 6 female, with a mean age of 25.6. All patients were accompanied with the exposure of tendon, muscle or screw. The skin defect ranged from 7 cm × 4 cm to 19 cm × 9 cm. ALl patients underwent pediele flap repair. The flap ranged from 10 cm × 6 cm to 20 cm × 15 cm. The proximal pedicle of the flap was sutured into a tubular. The position of the pediele was fixed by the external fixator. The pin was at the ulnar and the iliac (n = 5), and the radius and the iliac (n = 12). The immobilization lasted 3 to 8 weeks, 5. I weeks in average. Results All patients were followed up for 3 to 20 months, 11.3 in average. All pedicle flaps survived with no pressure ulcer, or no erosion in the axilla. No compartment syndrome or osteomyelitis occurred. Four to six week after surgery, the pedicle was cut. Infection occurred at the cutting end in 1 patient. The wound healed after addressing The wound in the other 16 patients healed successfully. The fracture of the ulnar and the radius healed 8. 5 or 15 weeks after surgery, 13.5 weeks in average. Eleven patients underwent second stage reshape and function restoration. The function of the hands and forearms recovered satisfactorily. Eleven patients returned to their work. Six patients can live with basic function for living. Conclusions The external flxator used for complex tissue defect in the forearm can keep the position of the pedicle, replacing plaster fixation. It can reduce the incidence of flap and vessel spasm, and get good outcomes.