逆行岛状腓动脉穿支皮瓣联合Masquelete技术治疗跟骨骨折术后骨感染伴组织缺损

刘衍松; 张允会; 伊力扎提·伊力哈木; 刘爱蓬; 曹天勇; 张文汉; 冯光

doi:10.16016/j.1000-5404.202101048

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逆行岛状腓动脉穿支皮瓣联合Masquelete技术治疗跟骨骨折术后骨感染伴组织缺损

专题报道：皮肤创面与瘢痕修复研究 | 更新时间：2026-01-09

- 逆行岛状腓动脉穿支皮瓣联合Masquelete技术治疗跟骨骨折术后骨感染伴组织缺损
- Retrograde island peroneal artery perforator flap combined with Masquelete technique in treatment of postoperative bone infection with tissue defect
- 第三军医大学学报 2021年43卷第11期页码：1051-1056
- 作者机构：
  
  1.221004 江苏徐州, 徐州仁慈医院: 创面修复科
  2.221004 江苏徐州, 徐州仁慈医院: 足踝外科
  3.100080 北京, 解放军第四临床医学中心烧伤整形科
- 作者简介：
  
  [冯光，E-mail：fengguang_304@aliyun.com FENG Guang, E-mail: fengguang_304@aliyun.com
- 基金信息：
- DOI：10.16016/j.1000-5404.202101048
  中图分类号： R619;R622.1;R683.42
- 收稿：2021-01-06，
  
  修回：2021-03-02，
  
  纸质出版：2021-06-15
- 稿件说明：
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刘衍松, 张允会, 伊力扎提·伊力哈木, 等. 逆行岛状腓动脉穿支皮瓣联合Masquelete技术治疗跟骨骨折术后骨感染伴组织缺损[J]. 第三军医大学学报, 2021,43(11):1051-1056.

Yansong LIU, Yunhui ZHANG, Yilihamu YILIZATI, et al. Retrograde island peroneal artery perforator flap combined with Masquelete technique in treatment of postoperative bone infection with tissue defect[J]. Journal of Third Military Medical University, 2021, 43(11): 1051-1056.
刘衍松, 张允会, 伊力扎提·伊力哈木, 等. 逆行岛状腓动脉穿支皮瓣联合Masquelete技术治疗跟骨骨折术后骨感染伴组织缺损[J]. 第三军医大学学报, 2021,43(11):1051-1056. DOI： 10.16016/j.1000-5404.202101048.

Yansong LIU, Yunhui ZHANG, Yilihamu YILIZATI, et al. Retrograde island peroneal artery perforator flap combined with Masquelete technique in treatment of postoperative bone infection with tissue defect[J]. Journal of Third Military Medical University, 2021, 43(11): 1051-1056. DOI： 10.16016/j.1000-5404.202101048.

摘要

目的

探讨逆行岛状腓动脉穿支皮瓣联合Masquelete技术对跟骨骨折术后骨感染伴组织缺损的临床疗效。

方法

收集徐州仁慈医院2017年12月至2020年6月跟骨骨折术后骨感染伴组织缺损患者18例，其中男性15例，女性3例，年龄33~64岁，平均42.2岁，修复前骨质缺损2 cm×2 cm×1 cm~ 3 cm×4 cm×3 cm，皮肤软组织缺损5 cm×1 cm~7 cm×2.5 cm。采用分次住院手术的方式：第1次住院予以清创、病灶清除后载抗生素骨水泥填塞骨质缺损、腓动脉穿支皮瓣修复创面。第2次住院取出骨水泥、游离植骨修复骨质缺损。术后观察切口愈合、皮瓣存活情况，监测血降钙素原、C反应蛋白、白介素6等的变化，随访观察评估皮瓣质地变化、骨质愈合、骨感染复发情况。

结果

18例患者创面均愈合，其中3例于皮瓣修复术前行2次清创，并辅助以封闭负压引流装置使用。术后各炎症指标均趋向正常，皮瓣均存活良好，各切口均一期愈合。1例患者骨质缺损较浅，骨水泥取出后以富血小板血浆(PRP)凝胶机化填塞骨缺损空腔，未行髂骨植骨。平均住院次数2.13次，人均住院治疗时间31.3 d。随访6~35个月，植骨处骨质愈合满意，无感染复发。

结论

利用逆行岛状腓动脉穿支皮瓣联合Masquelete技术治疗跟骨骨折术后骨感染伴组织缺损创面覆盖成功率高，植骨愈合满意，感染控制佳，疗效显著，且手术难度相对较低，易在临床推广。

Abstract

Objective

To investigate the clinical effectiveness of retrograde island peroneal artery perforator flap combined with Masquelete technique in the treatment of bone infection with tissue defect after calcaneal fracture.

Methods

A total of 18 patients with bone infection associated with tissue defect after calcaneal fracture surgery were collected from Xuzhou Benevolent Hospital from December 2017 to June 2020. They were 15 males and 3 females

and aged from 33 to 64 years (averagely 42.2 years). The bone defect was 2 cm×2 cm×1 cm ~ 3 cm×4 cm×3 cm

and skin and soft tissue defect was 5 cm×1 cm~7 cm×2.5 cm before repair. Multiple inpatient surgeries was adopted. Debridement was performed at the first hospitalization

bone defect was packed with antibiotic bone cement after lesion removal

and peroneal artery perforator flap was used to repair the wound. In the second hospitalization

bone cement was removed and free bone graft was used to repair the bone defect. After surgery

incision healing and flap survival were observed

blood procalcitonin

C-reactive protein and interleukin-6 levels were monitored

and flap texture changes

bone healing and bone infection recurrence were observed and evaluated.

Results

Wounds of 18 patients were healed

and 3 of them underwent debridement twice before the flap repair and were assisted with a closed negative pressure drainage device. Postoperative inflammatory indexes tended to be normal

all flaps survived well

and all incisions healed in the first stage. One patient had a shallow bone defect

and after the bone cement was removed

platelet rich plasma (PRP) gel was used to mechanically fill the bone defect cavity without iliac bone graft. The patients had an average time of hospitalizations for 2.13

and an average length of hospitalization for 31.3 d. In the end of 6 to 35 months' follow-up period

satisfactory outcomes were achieved and no recurrences were observed.

Conclusion

Retrograde island peroneal artery perforator flap combined with Masquelete technique obtains good effectiveness in treatment of bone infection with tissue defect after calcaneal fracture

with quite high wound coverage

satisfactory bone graft healing

well infection control

and obvious curative effectiveness. It is easy to operate and worthy of clinical promotion.

关键词

Keywords

references

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