Objective To study
the vein transplantation bridge vascular pedicle in free phil flap transplantation treatment of limb long bone trauma infectious defects of bone and soft tissue defects after surgical method and curative effect. Methods 17 cases of patients with infective limbs long bone defects of bone, male 11 cases, female 6 cases; 1.5~55 years old, average 1.5 years; Bone defect site: 8 cases of femoral, tibia in 5 cases, humerus (3 cases), ulna in 1 case; 8 cases consolidated soft tissue defect, the defect in the range of 5.0cm×3.0cm~17.0cm x 5.5cm. Application of venous bridge fibula flap transplantation dynamic and venous vascular pedicle 4~15cm long, 7.6cm. Transplantation of fibula flap area minimum 6.5cm x 4.0cm, the largest 18.0 cm×6.0cm. First to infection of bone defect in the end after thorough lesions cleared, use the VSD lavage drainage 2~3 weeks. After being local infection control, and then design taking fibula flap and fibular flap transplantation and the reconstruction of bone scaffold, and at the same time to repair soft tissue defect. Stay fibula flap transplantation and properly fixed in the district, at a little distance away from the wound health site, dissecting out the backflow of blood supply arteries and veins of the area, from venous transplantation after the bridge, leads to the area and fibula flap vascular pedicle line end to end anastomosis. Results infective bone defect by area after treatment with lesions cleared completely, the VSD, fresh granulation tissue growth. 17 cases of fibula flap surgery through smoothly, not in blood vessel crisis. 17 cases of postoperative wound healing in 11 cases, 6 cases of delay 1~2 weeks to heal. Follow-up of 9 months to 5 years, an average of 2 and a half years. 15 cases were primary healing bone defect, 2 cases of fibular side and the area has healed again healing after surgery. Fracture healing of stress fibula fracture after transplantation in 1 case. Clinical infective bone defect healing time 4.2~7.8 months, an average of 5.9 months, consult Enneking system scores, limb functional recovery rate is 89.3%, for the area without significant complications. Conclusion infectious bone soft tissue condition of long bone defect treatment cycle is long, difficult repair technology. Venous transplantation bridge free fibula flap vascular pedicle (skin), not only can effectively infectious bone to repair long bone defect, and filling the die cavity, and can improve the local blood supply of bone defect, infection control, and to repair soft tissue defects at the same time, is to treat limb long bone defects of bone and consolidation of soft tissue defect of the effective means. Operation requires a higher level of microsurgical technique and is has certain risk, but can obviously shorten period of treatment, maximize the restoration of limb function.
Posted by: Gao-hong Ren, Professor, Nanfang Hospital, Nanfang Medical University, China (31-Aug-2014)