1 The blood supply to the leg is special, and the skin on the surface of the tibia is thin. Severe leg trauma, combined with other bone trauma or serious organ damage. Julian 3 debridement in the Department of Orthopaedics, Shanghai Ninth People's Hospital is incorrect: unhealthy meat such as necrosis is not completely removed or too much healthy meat is removed. 4. There is no anatomical reduction at the fracture end: the fracture end is out of position and pressed on the skin. 5. Wrong choice of internal fixation method: improper plate fixation after tibial fracture; 6. Wrong postoperative treatment and functional exercise: long-term plaster fixation and premature exercise. All of the above reasons have complications such as infection, nonunion and delayed healing to varying degrees, which will lead to the exposure of tibia and steel plate in severe cases. How to deal with the exposure of infected steel plate in the second leg fracture wound? 1 dressing change to keep the wound clean (Chinese medicine can be used to detoxify and promote granulation) 2 Closed negative pressure suction 3 Extended debridement 4 Skin grafting 3 How to deal with long-term and refractory exposure of calf bone and steel plate? After the above treatment, the fracture can be internally aligned and fixed, and the bone and steel plate of the fracture surface are still exposed, and the surrounding scar is serious, and the skin and soft tissue conditions are poor, resulting in the exposure of the hard-to-heal calf bone and steel plate. It is difficult to deal with this kind of patients: there are foreign bodies such as steel plates and screws in the infected site, and the wound is difficult to heal without removal, but the fracture has not healed completely, and removal and fixation may lead to the fracture shifting again. At this time, the orthopedic surgeon will feel in a dilemma and need plastic surgery. Plastic surgeons often perform more thorough debridement on the exposed part, remove soft tissue and necrotic bone tissue, such as necrotic flesh, to form a completely clean calf defect, and then take a healthy soft tissue from other parts of the body to the calf defect and completely cover and seal it. This kind of surgery relies on microsurgery to suture tiny blood vessels, so that the transplanted healthy soft tissue can survive. Due to various treatment methods, the distribution of blood vessels in the calf is unknown, and sometimes angiography and scar repair are needed. Therefore, such patients are complicated and need good medical conditions and experienced doctors to deal with them. Four fractures have healed, but the steel plate is exposed, and there are osteomyelitis or bone defects at the same time. What should I do? The basic process is the same as above. When osteomyelitis occurs, antibiotics can be used locally in the calf to enhance the local anti-infection ability, and the exposed part of the steel plate can be transplanted with muscles with rich blood supply. Bone defect can be transplanted to the exposed part of steel plate with rich blood supply. Is the scar after fracture operation suitable for plastic surgery when taking steel plate? When is the scar after fracture surgery suitable for plastic surgery? Postoperative scar shaping can be completed in one stage by steel plate resection, but steel plate resection is an orthopedic surgeon and incision repair is a plastic surgeon, which needs cooperation. Scar plastic surgery is generally recommended after 6 months, and the longer the better. In the stage of scar hyperemia and hyperplasia, it is suggested to use local compression to limit scar hyperplasia and promote calm. After the incision is healed, there will definitely be scars, just a matter of size. There are many factors leading to scar formation in surgical incision. The effect of scar repair depends on the location and area of scar. If it is at the joints such as ankles and knees, the effect is worse and the repair is more difficult. How to deal with fracture complicated with vascular nerve injury, skin avulsion or defect? Fracture with vascular injury can be divided into different pathological types: vascular rupture, vasospasm, vascular contusion, vascular compression, pseudoaneurysm, arteriovenous fistula and so on. The principle of treatment is to stop bleeding in time and correct shock; Do a good job of debridement on the basis of saving the lives of the wounded; Improve the treatment of injured blood vessels, restore limb circulation as soon as possible, and save limbs and reduce disability. Nerve injury can be divided into nerve rupture, axon rupture, nerve apraxia, nerve stimulation and other types. According to different types, surgical or non-surgical therapy can be used to restore the function of damaged nerves. Fracture with skin avulsion or defect can be replanted in situ, free skin grafting or skin flap transfer on the basis of debridement. Tip: Any advice on diseases can't replace the face-to-face diagnosis of medical practitioners. All outpatient hours are for reference only, subject to the announcement of the hospital on the same day.