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首页> 外文期刊>Injury >Sequential therapy of vacuum sealing drainage and free-flap transplantation for children with extensive soft-tissue defects below the knee in the extremities
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Sequential therapy of vacuum sealing drainage and free-flap transplantation for children with extensive soft-tissue defects below the knee in the extremities

机译：肢体膝下以下广泛软组织缺损儿童的真空封闭引流和皮瓣移植的序贯治疗

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Purpose: The aim of the study is to evaluate the surgical technique and clinical significance of the sequential therapy of vacuum sealing drainage (VSD) and free-flap transplantation for children with extensive soft-tissue defects below the knee in the extremities. Methods: Twenty-two children (aged from 3 to 10 years) received sequential therapy of VSD and free-flap transplantation. All cases suffered from extensive area soft-tissue defects and exposure or partial defects of bones, tendons and other deep tissues. The wound sizes varied from 10 cm × 6 cm to 30 cm × 22 cm. Amongst 22 cases, 12 cases had fresh wounds and the remaining 10 children had necrotising infection. After complete debridement, the wounds were covered by VSD. External fixation or Kirschner-wire fixation should be performed for the cases complicated by unsteady fractures. After the removal of negative pressure VSD devices, free-flap transplantations were performed in 8 cases after debridement, and 14 cases received combined therapy of free-flap transplantation and skin grafting depending upon the severity of soft-tissue and deep-tissue defects. The flap survival and wound healing were followed up postoperatively. Results: After VSD treatment, the infection of deep-tissue exposure was effectively prevented, and granulation tissues surrounding the exposed areas of tendons and bones grew well. All patients who received free-flap transplantation at the second stage survived without the occurrence of vascular crisis, infection or sinus formation. During follow-up ranging from 6 to 24 months, all the patients were satisfied with the morphological appearance and functional recovery of the affected limbs. Conclusion: Sequential therapy of VSD and free-flap transplantation can serve as a reliable option for children with extensive soft-tissue defects below the knee in the extremities and exposed deep tissues, after complete debridement, which significantly shortens remedy period, enhances success rate for surgery and achieves maximal restoration of limb function.
机译：目的：本研究的目的是评估四肢膝下软组织缺损患儿采用真空密封引流（VSD）和自由瓣移植序贯治疗的手术技术和临床意义。方法：22名3至10岁的儿童接受了VSD顺序治疗和自由皮瓣移植。所有病例均遭受大面积软组织缺损以及骨骼，腱和其他深层组织的暴露或部分缺损。伤口大小从10厘米×6厘米到30厘米×22厘米不等。在22例中，有12例有新鲜伤口，其余10例儿童有坏死性感染。完全清创后，伤口用VSD覆盖。对于不稳定骨折并发的病例，应进行外固定或克氏针固定。去除负压VSD装置后，清创后8例进行了游离皮瓣移植，根据软组织和深层组织缺损的严重程度，有14例接受了游离皮瓣移植和皮肤移植的联合治疗。术后随访皮瓣存活和伤口愈合情况。结果：经VSD治疗后，可有效预防深层组织暴露的感染，并且在肌腱和骨骼暴露区域周围的肉芽组织生长良好。所有在第二阶段接受皮瓣移植的患者均存活下来，没有发生血管危机，感染或鼻窦形成的情况。在6至24个月的随访期间，所有患者对患肢的形态学外观和功能恢复均感到满意。结论：VSD序贯治疗和自由瓣移植可以为完全清创术后四肢膝下广泛的软组织缺损和暴露的深层组织的患儿提供可靠的选择，显着缩短了补救期，提高了成功率。手术并实现肢体功能的最大恢复。

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