一期皮瓣覆盖内固定治疗严重腿部开放性骨折：Gustilo III级损伤病例系列。

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports Pub Date : 2025-09-08 DOI:10.1016/j.ijscr.2025.111918

Samir Ben Salah , Aymen Benabdellah , Najib Abdeljaouad , Hicham Yacoubi

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引用次数: 0

摘要

背景：本研究报告了我们对10例开放性胫骨骨折（Gustilo IIIa型或IIIb型）采用内固定和软组织覆盖相结合的单阶段手术方法的治疗经验。材料和方法：我们进行了一项前瞻性研究，包括所有Gustilo III型开放性胫骨骨折患者。每个病例都进行了全面的临床和放射学评估，包括标准放射摄影和计算机断层血管造影（CTA）。外科治疗包括在单次手术中使用带蒂的筋膜皮瓣或肌肉皮瓣进行内植骨和立即软组织重建。结果：主要病因为道路交通事故，摩托车手占80%。患者平均年龄18 ~ 45岁，所有患者均在伤后6小时内入院。手术干预包括积极的伤口清创，血管和神经修复，髓内钉和立即皮瓣覆盖。术后平均5个月实现放射学骨愈合。讨论：单阶段入路治疗胫骨开放性骨折并伴有软组织重建具有显著的临床和经济优势。通过消除对二次手术的需要，该方法缩短了总体治疗时间，加速了功能恢复，并最大限度地降低了医疗成本。在一次手术中，骨折稳定和软组织覆盖的整合优化了资源利用，同时改善了患者的预后。结论：我们的研究结果表明，Gustilo III型胫骨开放性骨折的一期手术治疗结合明确固定和立即皮瓣覆盖在临床上是有效和经济的。该方法缩短了恢复时间，减轻了经济负担，是复杂开放性骨折管理的可行策略。

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Primary flap coverage with internal fixation in severe open leg fractures: A case series on Gustilo grade III injuries

Background

This study presents our experience in managing 10 cases of open tibial fractures (Gustilo type IIIa or IIIb) through a single-stage surgical approach combining internal fixation and soft tissue coverage.

Materials and methods

We conducted a prospective study including all patients with Gustilo type III open tibial fractures. Each case underwent comprehensive clinical and radiological assessment, including standard radiography and computed tomography angiography (CTA). Surgical management consisted of internal osteosynthesis with immediate soft tissue reconstruction using either pedicled fasciocutaneous or muscle flaps in a single operative session.

Results

The predominant etiology was road traffic accidents, with motorcyclists accounting for 80 % of cases. The mean patient age ranged from 18 to 45 years, and all patients were admitted within 6 h post-injury. Surgical intervention included aggressive wound debridement, vascular and nerve repair, definitive intramedullary nailing, and immediate flap coverage. Radiological bone union was achieved at a mean of 5 months postoperatively.

Discussion

The single-stage approach for open tibial fractures with concomitant soft tissue reconstruction demonstrated significant clinical and economic advantages. By eliminating the need for secondary procedures, this method reduced overall treatment duration, accelerated functional recovery, and minimized healthcare costs. The integration of fracture stabilization and soft tissue coverage in a single surgical session optimizes resource utilization while improving patient outcomes.

Conclusion

Our findings suggest that single-stage surgical management of Gustilo type III open tibial fractures combining definitive fixation with immediate flap coverage is both clinically effective and cost-efficient. This approach enhances recovery times, reduces financial burdens, and represents a viable strategy for complex open fracture management.

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