A Why is it most likely for the bone and plate to be exposed after calf fracture surgery? 1.The blood supply of the lower leg is special and the skin on the surface of the tibia is thin. 2.Severe calf trauma, combined with other bone trauma or with severe organ damage. 3, Incorrect debridement surgery: necrosis and other unhealthy skin is not completely removed or too much healthy skin is removed. 4.Fracture end not anatomically repositioned: the fracture end is poorly aligned and compresses the skin. 5. Wrong choice of internal fixation: improper fixation of tibial fracture with plate, 6. Wrong postoperative treatment and functional exercise: long-term compression with plaster fixation and too early weight bearing activities. All the above reasons lead to different degrees of infection, bone nonunion, delayed healing and other complications, and in serious cases, it will lead to tibia and plate exposure. How to deal with infected wound and exposed plate of calf fracture? 1, change the medicine to keep the wound clean (Chinese medicine can be used to remove the poison and regenerate the muscle) 2, closed negative pressure suction 3, expand the wound 4, skin grafting surgery 3 How to deal with the long term, difficult to heal tibia bone and plate exposure? After the above treatment methods, the fracture alignment and internal fixation can be done, but the fracture wound bone and plate are still exposed, and the surrounding scars are serious and the skin and soft tissue conditions are poor, which forms the difficult-to-heal calf bone and plate exposure, and the treatment of this kind of patients is more tricky: there is a foreign body of plate screw in the infected area, and if it is not taken out, it is difficult for the wound to be healed, while the fracture has not been completely healed, and the internal fixation is taken out for fear that the fracture will be re-displaced. The fracture has not completely healed, and if the internal fixation is removed, the fracture may be displaced again. At this point, the orthopedic surgeon will feel the dilemma, and need the surgery of the orthopedic surgeon. The orthopedic surgeon will often first perform a more thorough debridement of the exposed area, removing soft tissues such as necrotic and potentially unhealthy skin and flesh, and necrotic bone tissue to create a completely clean calf defect, and then take a piece of healthy soft tissue from another part of the body to the calf defect to completely cover and close it. This surgical procedure relies on microsurgical techniques to suture the tiny blood vessels so that the transplanted healthy soft tissue can survive. Angiography is sometimes required due to the unknown distribution of blood vessels in the calf as a result of various treatments. Thus, such patients are more complicated and require good medical conditions in hospitals and experienced doctors to handle them. IV What should I do if the fracture has been attached and grown, but the plate is exposed and there is osteomyelitis or bone defect? The basic procedure is the same as above. Osteomyelitis can be treated with localized antibiotics in the lower leg to strengthen the local resistance to infection, and a muscle graft with a rich blood supply can be used to graft the exposed plate. Bone defects can be treated with bone grafts with a rich blood supply to the plate exposure. V Is plastic surgery appropriate for scars after fracture surgery when the plate is removed? When is it appropriate to reconstruct a scar after fracture surgery? Scar reconstruction after surgery can be done in the same phase as plate removal, but plate removal is done by orthopedic surgeons and incision repair is done by plastic surgeons, which needs to be coordinated. Scar reconstruction is usually recommended after 6 months after surgery, the longer the better. During the period of scar congestion and proliferation, it is recommended to apply local compression to limit scar proliferation and promote flattening. The incision will definitely have a scar after healing, it is just a matter of size. Surgical incision scar formation has a variety of factors, the effect of scar repair depends on the site and area of the scar, if it is in the ankle and knee and other joints, the effect is worse, the repair is more difficult. How to deal with fracture combined with vascular nerve injury and skin avulsion or defect? Fractures combined with vascular injuries are divided into different pathological types: vascular dissection, vasospasm, vascular contusion, vascular compression, pseudoaneurysm, arteriovenous fistula and so on. The principle of treatment is to stop bleeding in time and correct shock; to do a good debridement on the basis of saving the life of the injured; to improve the treatment of damaged blood vessels, restore the circulation of the limb as soon as possible, preserve the limb and reduce disability. Nerve injury is categorized into nerve fracture, axonal fracture, nerve disuse, nerve irritation, etc. Surgical or non-surgical therapies can be adopted according to different types, aiming at restoring the function of damaged nerves. Fractures combined with skin avulsions or defects can be treated with techniques such as in situ replantation, free skin grafting or transfer flaps on the basis of debridement.