小儿患者胫骨开放性骨折复杂软组织闭合的急性故意变形。

Eplasty Pub Date : 2022-08-09 eCollection Date: 2022-01-01
Jordan N Halsey, Christopher A Iobst, Gregory D Pearson
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引用次数: 0

摘要

背景。在儿童人群中,与Gustillo 3B/3C骨折相关的下肢损伤需要特别考虑。如果可能的话,儿科患者应该尝试保留肢体,并且通常存在于骨骨折上方的软组织缺损是实质性的。在整形外科中用于处理Gustillo 3B/3C骨折的传统算法,被称为重建阶梯,在大多数情况下建议皮瓣重建与自由组织转移,因为区域选择通常不可用或不能提供足够的覆盖。自由组织移植程序是广泛的,需要一个供体;它们通常需要多个程序和随后的修改。此外,当伴随损伤或医疗条件存在时,患者可能不适合进行游离皮瓣。然而,对于经常被整形外科医生忽视的下肢严重损伤的儿童患者,确实存在另一种选择。骨科文献中的几篇文章描述了临时肢体变形的效用,允许软组织闭合,随着时间的推移逐渐纠正骨畸形。虽然这些手术的愈合过程需要几个月的时间,但不需要进行广泛的软组织重建,最终的结果是腿部功能正常,覆盖范围足够。这篇文章报告的情况下,这种类型的骨和软组织重建的病人进行了良好的整体结果。该技术可作为儿童下肢重建的一种选择,在某些情况下是有用的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Acute Intentional Deformation of Open Tibial Fractures for Complex Soft Tissue Closure in the Pediatric Patient.

Background. Lower extremity injuries in the pediatric population that are associated with Gustillo 3B/3C fractures require special consideration. Limb salvage should be attempted in the pediatric patient if at all possible, and oftentimes the soft tissue defect that is present over the bony fracture is substantial. The traditional algorithm used in the management of Gustillo 3B/3C fractures in plastic surgery, referred to as the reconstructive ladder, would recommend flap reconstruction with free tissue transfer in most cases because regional options are often unavailable or do not provide adequate coverage. Free tissue transfer procedures are extensive and necessitate a donor site; they often require multiple procedures and subsequent revisions. Furthermore, when concomitant injuries or medical conditions are present, a patient may not be an appropriate candidate for a free flap. Another option, however, does exist for the pediatric patient with a significant lower extremity injury that is often overlooked by the plastic surgeon. Several articles in the orthopedic literature describe the utility of temporary limb deformation to allow for soft tissue closure, with gradual correction of the bony deformity over time. Although the healing process for these procedures take several months, there is no need for extensive soft tissue reconstruction and the ultimate result is a leg that is functional with adequate coverage. This article reports a case where this type of bone and soft tissue reconstruction was performed in a patient with an excellent overall outcome. This technique could be useful in select cases as an option in pediatric lower extremity reconstruction.

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