Effect of negative pressure wound therapy combined with periosteum-carrying lower lateral malleolus flap in repairing forefoot soft tissue defects

doi:10.3760/cma.j.issn.1007-1245.2024.18.006

Abstract

Abstract:

Objective　To investigate the effect of negative pressure wound therapy (NPWT) combined with periosteum-carrying lower lateral malleolus flap in repairing forefoot soft tissue defects. Methods　This study was a randomized controlled trial. A total of 92 patients with forefoot soft tissue defects admitted to Shaanxi Provincial Corps Hospital of the Chinese People's Armed Police Forces from February 2020 to February 2023 were divided into two groups by touching ball method, with odd numbers allocated to the control group (46 cases) and even numbers to the observation group (46 cases). In the control group, there were 25 males and 21 females, aged (38.69±3.25) years, including 24 cases of mechanical injury, 17 cases of traffic injury, and 5 cases of crushing injury. In the observation group, there were 24 males and 22 females, aged (38.51±3.12) years, including 25 cases of mechanical injury, 15 cases of traffic injury, and 6 cases of crushing injury. The control group was treated with traditional debridement combined with periosteum-carrying lower lateral malleolus flap repair, and the observation group was treated with NPWT combined with periosteum-carrying lower lateral malleolus flap repair. The clinical indicators, flap survival rate, pain degree [Visual Analogue Scale (VAS)], ankle function [American Orthopedic Foot and Ankle Society Ankle Hindfoot Scale (AOFAS)], sensory function, and complications were compared between the two groups. χ² test and t test were used. Results　After treatment, the operation time of the observation group was (44.96±4.25) min, the antibiotic use time was (5.69±1.14) d, the hospital stay was (18.98±2.87) d, the dressing change times were (4.28±1.01), the flap harvest area was (47.26±4.85) cm², and those of the control group were (61.02±5.69) min, (11.25±2.05) d, (28.65±3.16) d, (9.26±1.95), and (55.36±5.12) cm², with statistically significant differences (t=12.753, 16.464, 16.251, 12.355, and 8.309, all P<0.001). The overall survival rate of skin flap was 95.65% (44/46) in the observation group and 71.74% (33/46) in the control group, with a statistically significant difference (χ²=9.638, P=0.002). The AOFAS score of the observation group was higher than that of the control group [(19.79±3.02) points vs. (16.02±2.84) points], and the VAS score was lower than that of the control group [(2.32±0.59) points vs. (4.21±0.85) points], with statistically significant differences (t=6.168 and 12.389, both P<0.001). The recovery effect of sensory function in the observation group was better than that in the control group, and the total complication rate was lower than that in the control group, with statistically significant differences (χ²=9.902, P=0.007; χ²=4.389, P=0.036). Conclusion　NPWT combined with periosteum-carrying lower lateral malleolus flap repair demonstrates superior effectiveness in repairing forefoot soft tissue defects compared to traditional methods, shortening the treatment time, improving the flap survival rate, alleviating the pain, and enhancing the functional recovery.

Key words:

Negative pressure wound therapy, Periosteum-carrying lower lateral malleolus flap, Forefoot soft tissue defects, Ankle joint function, Sensory function

摘要：

目的　探讨负压封闭引流联合携带骨膜的低位外踝上皮瓣修复前足软组织缺损的效果。方法　本研究为随机对照试验。选取2020年2月至2023年2月武警陕西省总队医院收治的92例前足软组织缺损患者，采用摸球法分组，奇数为对照组（46例），偶数为观察组（46例）。对照组男25例，女21例，年龄（38.69±3.25）岁，机械损伤24例，车祸伤17例，压砸伤5例，予以传统清创联合携带骨膜的低位外踝上皮瓣修复治疗；观察组男24例，女22例，年龄（38.51±3.12）岁，机械损伤25例，车祸伤15例，压砸伤6例，予以负压封闭引流联合携带骨膜的低位外踝上皮瓣修复治疗，两组均随访6个月。比较两组临床相关指标、皮瓣成活率、疼痛程度［视觉模拟评分法（VAS）］、踝关节功能［美国足踝外科协会踝-后足评分系统（AOFAS）］、感觉功能、并发症发生情况。采用χ²检验、t检验。结果　观察组手术时间（44.96±4.25）min、抗生素使用时间（5.69±1.14）d、住院时间（18.98±2.87）d、换药次数（4.28±1.01）次、皮瓣切取面积（47.26±4.85）cm²，对照组分别为（61.02±5.69）min、（11.25±2.05）d、（28.65±3.16）d、（9.26±1.95）次、（55.36±5.12）cm²，差异均有统计学意义（t=12.753、16.464、16.251、12.355、8.309，均P<0.001）。术后6个月，观察组皮瓣成活总体优良率为95.65%（44/46），对照组为71.74%（33/46）］，差异有统计学意义（χ²=9.638，P=0.002）。治疗6个月后，观察组AOFAS评分高于对照组［（19.79±3.02）分比（16.02±2.84）分］、VAS评分低于对照组［（2.32±0.59）分比（4.21±0.85）分］，差异均有统计学意义（t=6.168、12.389，均P<0.001）。术后6个月，观察组患者的感觉功能恢复效果优于对照组（χ²=9.902，P=0.007）。观察组并发症总发生率低于对照组［6.52%（3/46）比21.74%（10/46）］，差异有统计学意义（χ²=4.389，P=0.036）。结论　负压封闭引流联合携带骨膜的低位外踝上皮瓣修复治疗前足软组织缺损效果显著，可以缩短治疗时间，提高皮瓣存活率，减轻患者疼痛，促进功能恢复。

关键词:

负压封闭引流, 携带骨膜的低位外踝上皮瓣, 前足软组织缺损, 踝关节功能, 感觉功能

Lian Haipeng, Wang Ke, Gu Yunong, Li Jianwu, Bai Guoxi, Li Zhanning.

Effect of negative pressure wound therapy combined with periosteum-carrying lower lateral malleolus flap in repairing forefoot soft tissue defects [J]. International Medicine and Health Guidance News, 2024, 30(18): 3018-3022.

连海鹏王科古雨浓李建武白国玺李战宁.

负压封闭引流联合携带骨膜的低位外踝上皮瓣在前足软组织缺损修复中的应用效果 [J]. 国际医药卫生导报, 2024, 30(18): 3018-3022.

References

[1] 尹路,宫可同,殷中罡,等.游离穿支皮瓣联合游离植皮修复足踝部软组织缺损的疗效观察[J].中国修复重建外科杂志,2017,31(3):319-322.DOI:10.7507/1002-1892. 201610122.
[2] 霍君艺,赵卓伟,全猛,等.VSD联合胫后动脉内踝上穿支皮瓣修复足踝部皮肤软组织缺损[J].中国美容整形外科杂志,2020,31(11):672-675.DOI:10.3969/j.issn.1673-7040. 2020.11.011.
[3] 李文涛,董中洋,刘伟, 等.串联组合皮瓣修复前足负重区及周围大面积软组织缺损[J].中华手外科杂志,2023,39(2):147-149.DOI:10.3760/cma.j.cn311653-20220907-00234.
[4] 罗明华,杨华,吕志华,等. 负压封闭引流对胫腓骨开放性骨折术后感染患者微循环和Th1/Th2的影响[J]. 中华医院感染学杂志,2020,30(14):2192-2196. DOI:10.11816/cn.ni.2020-192131.
[5] 孟艳斌,张海瑞,魏建伟,等. 携带骨膜的低位外踝上皮瓣与小腿近端螺旋桨皮瓣接力修复前足电烧伤创面的效果[J]. 中华烧伤与创面修复杂志,2023,39(10):953-958. DOI:10.3760/cma.j.cn501225-20230421-00138.
[6] 何强,王喆,何昊. 经皮钢板内固定技术结合解剖锁定钢板治疗胫骨远端骨折的Johner-Wruhs评分疗效及预后分析[J]. 广西医科大学学报,2018,35(7):972-975. DOI:10.16190/j.cnki.45-1211/r.2018.07.018.
[7] 高建国,张致得,许再超,等. 带线锚钉治疗陈旧性外踝撕脱骨折合并踝关节不稳的临床研究[J]. 河北医科大学学报,2020,41(10):1224-1227,封3. DOI:10.3969/j.issn.1007- 3205.2020.10.024.
[8] Dean DM, Ho BS, Lin A, et al. Predictors of patient-reported function and pain outcomes in operative ankle fractures[J]. Foot Ankle Int, 2017, 38(5):496-501. DOI: 10.1177/1071100716688176.
[9] Gutkowska O, Martynkiewicz J, Mizia S, et al. Results of operative treatment of brachial plexus injury resulting from shoulder dislocation: a study with a long-term follow-up[J]. World Neurosurg, 2017, 105:623-631. DOI: 10.1016/j.wneu.2017.06.059.
[10] 任乾峰,许宇达,陈磊. 负压封闭引流联合游离髂腹股沟皮瓣修复儿童足踝部软组织缺损[J]. 临床骨科杂志,2018,21(3):379-380. DOI:10.3969/j.issn.1008-0287.2018. 03.050.
[11] 钟云祥,钟强,张雄辉,等.负压封闭引流联合小腿皮神经皮瓣修复足踝部软组织缺损[J].临床骨科杂志,2016,19(1):58-60.DOI:10.3969/j.issn.1008-0287.2016.01.023.
[12] 杨英果,班兴平,戈兵, 等.封闭负压引流技术在手足部软组织撕脱伤缺损治疗中的应用[J].临床骨科杂志,2019,22(3):317-319.DOI:10.3969/j.issn.1008-0287.2019.03.021.
[13] 何海珍,杨瑛艳,巫文强, 等.综合护理干预对同侧游离腕横纹穿支复合组织瓣修复手指皮肤软组织复合缺损的手术患者的临床应用效果[J].国际医药卫生导报,2022,28(15):2150-2153.DOI:10.3760/cma.j.issn.1007-1245.2022. 15.018.
[14] 曾德斌,张熙民,林崇正, 等.封闭负压引流在手部组织缺损皮瓣修复患者术后感染的控制效果观察[J].中华医院感染学杂志,2018,28(21):3297-3300.DOI:10.11816/cn.ni.2018-173621.
[15] 王思夏,战杰,吴锦生, 等.双叶股前外侧穿支皮瓣修复足部复杂软组织缺损[J].中国美容整形外科杂志,2021,32(2):111-113.DOI:10.3969/j.issn.1673-7040.2021.02.014.
[16] 姚清秀,张晓,吴晓静,等. 封闭式负压引流联合腓肠神经营养血管皮瓣修复足踝软组织缺损的标准护理干预[J]. 安徽医药,2018,22(3):557-560. DOI:10.3969/j.issn.1009- 6469.2018.03.045.
[17] 邓桂,杜远立,张坤,等. 负压封闭引流技术在足踝部皮瓣手术中的应用[J]. 生物骨科材料与临床研究,2017,14(1):51-52,后插5-后插6. DOI:10.3969/j.issn.1672-5972.2017. 01.013.
[18] 陈金,王光勇,周廷玉,等. 腓肠神经小隐静脉营养血管皮瓣联合VSD修复足踝及胫前软组织缺损的疗效观察[J]. 中华显微外科杂志,2018,41(5):487-489. DOI:10.3760/cma.j.issn.1001-2036.2018.05.018.
[19] 张宜之,张子清,肖春生,等. 带阔筋膜的股前外侧穿支皮瓣修复合并伸肌腱缺损的手足创面[J]. 中华整形外科杂志,2021,37(8):899-906. DOI:10.3760/cma.j.cn114453- 20200612-00355.
[20] 刘蕾,赵小瑜,黄春辉,等. 腓肠神经营养血管皮瓣联合封闭式负压引流修复足踝部创面临床研究[J]. 创伤与急危重病医学,2018,6(5):337-338. DOI:10.16048/j.issn.2095- 5561.2018.05.33.
[21] 苏畅,詹晓欢,王应琼,等. 负压封闭引流技术在小腿带蒂岛状皮瓣供区植皮中的应用[J]. 海南医学院学报,2018,24(17):1571-1573,1577. DOI:10.13210/j.cnki.jhmu. 20180917.00.
[22] 黄勇仪,陈伟明,黄彬,等. VSD联合腓动脉穿支皮瓣修复小儿足跟部软组织缺损[J]. 中华显微外科杂志,2017,40(3):292-294. DOI:10.3760/cma.j.issn.1001-2036.2017. 03.027.
[23] 吴晴晴,肖灿,林伟,等. 吻合神经的胫后动脉穿支螺旋桨皮瓣修复足内踝部软组织缺损[J]. 中国美容整形外科杂志,2020,31(3):153-156. DOI:10.3969/j.issn.1673-7040. 2020.03.009.
[24] 刘启生,马玉杰,王浩森,等. 保留腓动脉外踝后上穿支蒂的腓肠神经营养皮瓣修复儿童足跟皮肤软组织缺损[J]. 临床骨科杂志,2017,20(4):443-446. DOI:10.3969/j.issn.1008- 0287.2017.04.021.
[25] 周荣,巨积辉,唐林峰,等. 带感觉神经的股前外侧穿支皮瓣修复足底皮肤软组织缺损的临床效果[J]. 中华烧伤杂志,2021,37(5):453-459. DOI:10.3760/cma.j.cn501120- 20200309-00136.
[26] 欧昌良,邹永根,罗成,等. 负压封闭引流联合股前外侧穿支皮瓣修复足部软组织缺损[J]. 中国骨伤,2018,31(7):666-670. DOI:10.3969/j.issn.1003-0034.2018.07.015.
[27] 刘东,梁运海,董明,等. 足部软组织缺损修复中负压封闭引流与皮瓣移植的应用[J]. 中国组织工程研究,2015,19(7):1133-1137. DOI:10.3969/j.issn.2095-4344.2015.07.027.
[28] 李吉利,姚恒,王炜,等. 负压封闭引流联合逆行隐神经营养皮瓣移植对足踝部皮肤软组织缺损创面愈合的影响[J]. 中国煤炭工业医学杂志,2017,20(12):1407-1410. DOI:10.11723/mtgyyx 1007-9564 201712001.
[29] 李兴奎,徐跃,冯毓云.负压封闭引流联合股前外侧穿支皮瓣修复足部软组织缺损创面[J].中国美容医学,2022,31(11):12-16.DOI:10.15909/j.cnki.cn61-1347/r.005351.
[30] 周鑫,邹永根,唐林,等. 携带双侧腹壁浅动脉的下腹壁联体皮瓣修复足踝大面积软组织缺损[J]. 中国修复重建外科杂志,2021,35(11):1467-1471. DOI:10.7507/1002-1892. 202106040.