การรักษาแผลเปิดชนิดรุนแรง มีการติดเชื้อเรื้อรังของกระดูกที่ส้นเท้าหักจากอุบัติเหตุด้วย Vascularized Free Flap

บทคัดย่อ

Objective : The aim of this study is to evaluate the usability of the free myocutaneous and osteomyocutaneous flaps to reconstruct the large soft tissue and bone leftover defect after radical debridement of chronic osteomyelitis resulting from previous opened traumatic calcaneal fractures.

Patients and Methods : From October 2005 to August 2009 four patients (3 males and 1 female), age 22 to 52 years old with chronic osteomyelitis from traumatic opened calcaneal fractures were operated with vascularized free flap. Three male patients with latissimus dorsi myocutaneous free flap, and one female with pectoralis major osteomyocutaneous free flap. Follow -up period ranged from 12 to 24 months.

Results : All implanted free flaps survived completely and achieved the objectives to get rid of infection and to obliterate soft tissue and bony dead space as well as limb saving and early ambulation. This study projected no immediate and long term severe postoperative complications.

Conclusions : Key success factors of traumatic opened calcaneal fracture with chronic osteomyelitis to be healed includes the effective bone fracture and tissue defects management combined with treatment of chronic bone infection. Preoperative patient preparation and intraoperative intensive eradication of the dead and infected bone and soft tissues was followed by immediate coverage of the defects with vascularized free flap reconstruction. Postoperative closed monitoring of flap survival and infection control as well as long term follow up of the patients are recommended.