Clinical effects of chimeric perforator flaps in repairing wounds with bone or internal fixation exposure and wounds with osteomyelitis
Objective To explore the clinical effects of chimeric perforator flaps in repairing wounds with bone or internal fixation exposure and wounds with osteomyelitis.Methods This study was a retrospective observational study.From January 2018 to December 2022,20 patients with wounds with bone or internal fixation exposure and wounds with osteomyelitis who met the inclusion criteria were admitted to Beijing Jishuitan Hospital Affiliated to Capital Medical University,including 19 males and 1 female,aged from 21 to 73 years.Among the 21 wounds,there were 5 wounds with bone exposure,12 wounds with osteomyelitis,and 4 wounds with internal fixation exposure.After the debridement in the first stage,the wound area was 6 cm× 3 cm to 22 cm×10 cm.Then vacuum sealing drainage was carried out for 5 to 7 days.In the second stage,the wounds were covered with pedicled chimeric medial sural artery perforator flap,pedicled chimeric posterior tibialis artery perforator flap,free chimeric perforator flap pedicled with descending branch of lateral circumflex femoral artery,free chimeric medial sural artery perforator flap or free chimeric deep circumflex iliac artery perforator flap with incision area of 7 cmx5 cm to 25 cm×12 cm.The chimeric muscle flap was used to fill and cover irregular deep cavities.The wounds in the flap donor sites were sutured directly or repaired with medium-thickness skin grafts from the thigh.The survival of flap and the healing of wound in flap donor site were observed after operation.The recurrence of infection was followed up.Results Among the 18 free chimeric perforator flaps,16 flaps survived successfully;one flap experienced a venous crisis on the day of surgery and survived completely after emergency exploration and re-anastomosis;another one flap had partial distal necrosis,which healed after dressing changes.All the wounds in the flap donor sites healed evenly.All 3 pedicled chimeric perforator flaps survived;one of them developed sub-flap infection but healed after debridement and bone cement placement.The wound in the donor site of 1 flap developed incision dehiscence,which healed successfully after redebridement and suturing.The donor site wounds of the rest 2 flaps healed well.During 3 to 12 months of follow-up,the patients with wounds with bone or internal fixation exposure showed no signs of abnormal exudation or infection,and no infection recurrence was observed in patients with wounds with osteomyelitis.Conclusions The application of chimeric perforator flaps is effective in covering wounds,filling dead spaces,and controlling infection in wounds with bone or internal fixation exposure and wounds with osteomyelitis.Moreover,this method minimizes the damage to the donor site.
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