目的:评价基于旋股外侧动脉降支(d-LCFA)的抗生素骨水泥联合分叶型穿支皮瓣治疗足感染创伤性组织缺损的临床效果。根据增强手术后恢复(ERAS)的概念。
方法:自2019年12月至2022年11月,对10例感染性足外伤组织缺损患者采用抗生素骨水泥联合d-LCFA小叶穿支皮瓣治疗。该队列包括6名男性和4名女性,21至67岁。最初的感染控制是通过清创和抗生素骨水泥覆盖来实现的,9例需要一次清创,1例需要两次清创。控制感染后,利用d-LCFA小叶穿支皮瓣重建组织缺损,捐赠基地主要关闭。皮瓣面积12cm×6cm~31cm×7cm。术后随访包括评估皮瓣的存活率,供体部位愈合,和脚的行走功能。
结果:随访时间为7至24个月,平均14个月。所有病例均成功控制感染。皮瓣表现出优异的存活率,供体部位通过最初的意图愈合。根据美国骨科足踝协会(AOFAS)踝足-后足量表,疼痛和功能被评估为优秀的3例,在5个案例中很好,2例中度。
结论:应用抗生素骨水泥联合d-LCFA分叶穿支皮瓣是治疗足底感染性创伤组织缺损的有效方法,具有操作简便的优点。高重复性,和精确的疗效。d-LCFA小叶穿支皮瓣在伤口修复中的应用对供体部位的损伤最小,缩短住院时间,降低医疗费用,加速患者康复,与ERAS概念保持一致。因此,是一种值得临床推广的做法。
OBJECTIVE: To evaluate the clinical effectiveness of antibiotic bone cement combined with the lobulated perforator flap based on the descending branch of the lateral circumflex femoral artery (d-LCFA) in the treatment of infected traumatic tissue defects in the foot, in accordance with the Enhanced Recovery after Surgery (ERAS) concept.
METHODS: From December 2019 to November 2022, 10 patients with infected traumatic tissue defects of the foot were treated with antibiotic bone cement combined with the d-LCFA lobulated perforator flap. The cohort comprised 6 males and 4 females, aged 21 to 67 years. Initial infection control was achieved through debridement and coverage with antibiotic bone cement, requiring one debridement in nine cases and two debridements in one case. Following infection control, the tissue defects were reconstructed utilizing the d-LCFA lobulated perforator flap, with the donor site closed primarily. The flap area ranged from 12 cm×6 cm to 31 cm×7 cm. Postoperative follow-up included evaluation of flap survival, donor site healing, and ambulatory function of the foot.
RESULTS: The follow-up period ranged from 7 to 24 months, averaging 14 months. Infection control was achieved successfully in all cases. The flaps exhibited excellent survival rates and the donor site healed by first intention. Based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, pain and function were evaluated as excellent in 3 cases, good in 5 cases, and moderate in 2 cases.
CONCLUSIONS: The application of antibiotic bone cement combined with the d-LCFA lobulated perforator flap is an effective treatment for infected traumatic tissue defects of the foot with the advantages of simplicity, high repeatability, and precise curative effects. The application of the d-LCFA lobulated perforator flap in wound repair causes minimal damage to the donor site, shortens hospital stays, lowers medical expenses, and accelerates patient rehabilitation, aligning with the ERAS concept. Therefore, it is a practice worth promoting in clinical use.