広範囲皮膚欠損を伴う下肢外傷の治療

Abstract

Open fractures of the lower limb with massive skin defects are difficult to treat and a large number of studies have been made on application of free skin flap transfers and free vascularized bone transfers for salvage.However such techniques cannot always be used because of problems of manpower and technical difficulty. In such cases we have to rely on conventional treatment.Recently we conventionally treated two cases of type III-b fractures and a case of III-c fracture classified by Gustilo-Anderson with satisfactory results achieved. The importance of initial management cannot be overestimated.The first important point is acute reduction and stabilization with good alignment. External fixators play an important role in immediate fixation, however internal fixation is necessary in many situations.Even more important is wound management. When the wound is contaminated and extensive skin loss exists, we prefer to leave the wound open although the surface of the bone must be covered with skin or muscle.