Second-stage wound reconstruction for Gustilo type ⅢB、ⅢC open fractures with skin and soft tissue defects on the upper extremities
10.3760/cma.j.issn.1009-4598.2017.05.005
- VernacularTitle: 上肢GustiloⅢB、ⅢC型开放性骨折伴皮肤软组织缺损的二期创面修复
- Author:
Yongqiang KANG
1
;
Yongwei WU
;
Jun LIU
;
Yunhong MA
;
Yao LU
;
Tong YANG
;
Yongjun RUI
Author Information
1. Department of trauma orthopaedics, Wuxi 9th People's Hospital, wuxi 214062, China
- Publication Type:Clinical Trail
- Keywords:
Fractures, open;
Soft tissue injury;
Tissue transplantation
- From:
Chinese Journal of Plastic Surgery
2017;33(5):345-349
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical therapy for Gustilo type Ⅲ B、ⅢC open fractures with skin and soft tissue defects on the upper extremities.
Methods:From July 2014 to July 2016, 19 patients with Gustilo type Ⅲ open fractures (type ⅢB 12 cases , type ⅢC 7 cases) and soft-tissue defects in upper extremity were admitted, including 14 males and 5 females , aged 22 to 59 years (average 42 ). All the cases were treated by staged treatment. In the first stage, early debridement, nerves, vessels and tendons repairment, fixation of the fractures, VSD for the wound were performed. One patient underwent amputation 5 days after first operation. All the other 18 patients received flap transplantion, including 10 anterolateral thigh perforator flaps, 3 latissimus dorsal muscular flaps and 5 free lateral arm flaps.
Results:8 patients were followed up for an average duration of 14.5 months(ranged from 7 to 23 months). Partial necrosis happened at the distal end of one anterolateral thigh perforator flap and healed with skin-grafting.1 flap encountered vascular complication which survived with 5cm-in-width skin necrosis at the distal end of the flap after successful surgical exploration. 1 case had superficial infection at wound. The wounds at donor sites were primarily healed except for 1 case with skin graft necrosis and superficial infection. All the other flaps survived completely. The patients received 2-6 operations each. The average hospital stay was 34 days (12-71 days). All Skin flap texture was soft and had varying degrees of pigmentation. The flap sensory recovery was S2 in 4 cases, S3 in 9 cases, S4 in 5 cases. 1 case had obvious scar hyperplasia.
Conclusions:Staged surgical treatment in Gustilo type Ⅲ open fractures with soft-tissue defects in upper extremity provide a high survival rate of flaps and satisfactory results. The treatment is well tolerate by patients.
