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The Usefulness of Perforator Flaps for the Definitive Management of Exposed Hardware in Patients with Lower Extremity Fracture

Other Title
내고정판이 노출된 하지골절 환자 치료에서의 천공지 피판의 유용성
Authors
Kim, SM; Jeong, KS; Song, HK; Park, MC; Park, DH; Lee, IJ
Citation
Archives of Hand and Microsurgery, 23(3):206-216, 2018
Journal Title
Archives of Hand and Microsurgery
ISSN
2586-32902586-3533
Abstract
PURPOSE: Hardware exposure after the lower extremity fractures operation is challenging to manage and requires long-term treatment. The traditional management of exposed hardware usually includes hardware removal. The purpose of this study was to evaluate the proper treatment for the cases with exposed hardware in patients with lower extremity fracture.
METHODS: Between October 2011 and October 2015, a total of 14 cases of hardware exposure who had previously been managed for lower extremity fractures required surgical debridement, revised surgery by the orthopedic surgical team and reconstruction with fasciocutaneous perforator flaps. A retrospective chart review was performed.
RESULTS: Of the 14 cases included, 5 were open fractures at the time of the initial injury, and 9 were closed. The management of the exposed hardware was determined after examining the bony union status and device loosening. Anterolateral thigh free flap, posterior tibial artery perforator-based propeller flap, and peroneal artery perforator-based propeller flap were performed. All flaps survived without major complications. There were three cases of persistent infections that required the removal of the hardware again and repeated debridement. All three cases involved hardware that had been exchanged during the flap surgery because of loosening.
CONCLUSION: We achieved positive results by treating exposed hardware with fasciocutaneous perforator flaps and maintaining the original hardware, except in the cases where it had loosened. In cases with device loosening, there is possibility of progression to persistent infection and osteomyelitis even after properly treated with device exchange and soft tissue reconstruction.

목적: 하지골절 수술 후에 내고정판이 노출되면 해결이 어렵고 장기적인 치료를 요하는 경우가 많다. 이 연구를 통해 내고정판이 노출된 하지골절 환자에서 내고정판의 처리와 재건 후 결과에 대해 평가하고자 하였다.
방법: 하지골절 수술 이후 내고정판 노출로 변연절제술, 정형외과적 재수술, 근막피부 천공지 피판술을 받은 14명의 환자를 대상으로 후향적 의무기록 검토를 하였다.
결과: 연구에 포함된 14건 중 5건은 개방골절이었다. 9건은 폐쇄골절이었다. 상처 감염이 있는 경우가 10건, 골수염이 있는 경우가 3건이었다. 골유합 상태 및 내고정판이 느슨해진 정도에 따라 노출된 내고정판의 처리를 결정하였다. 11건은 내고정판을 유지, 3건은 내고정판이 느슨해져 있어 교체한 후 근막피부 천공지피판으로 재건하였다. 수술 이후 재발성 상처 감염을 보인 경우가 3건 있었고 이 경우들은 고정장치의 제거와 추가 변연절제술을 시행하였다. 이 3건의 증례는 모두 이전 수술에서 이미 고정장치 교체를 시행받은 증례들이었다.
결론: 수술 전 내고정판이 느슨해져 있는 경우에는 추후 적절한 내고정판 교체와 연조직 재건술 시행 후에도 재발성 상처감염 또는 골수염으로 진행될 가능성이 있다는 것을 확인하였다. 원래의 고정판을 유지한 경우에는 근막피천공지 피판술을 시행하여 긍정적인 결과를 얻었다.
Keywords
Lower extremityOrthopedic fixation devicesWounds and injuriesPerforator flap하지정형외과적 고정장치창상 및 손상천공지 피판
DOI
10.12790/ahm.2018.23.3.206
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Plastic & Reconstructive Surgery
Journal Papers > School of Medicine / Graduate School of Medicine > Orthopedic Surgery
AJOU Authors
김, 수민송, 형근박, 명철박, 동하이, 일재
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