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目的：探讨应用显微外科技术联合外固定支架修复下肢严重毁损伤造成的大面积皮肤软组织缺损，骨缺损、骨外露及主干血管损伤的可行性及疗效。方法回顾性分析2008年6月至2012年9月，我院收治的8例下肢严重毁损伤患者，男6例，女2例，平均年龄为42.6岁，骨折 Gusilo 分型：III B 型3例， III C 型5例，骨折部位：胫腓骨5例，胫腓骨合并跖趾骨3例。创面彻底清创；运用临时支架克氏针对骨折处进行复位固定；通过静脉移植及血管吻合修复血管损伤；对大面积脱套皮肤修薄后进行原位修复；采用负压封闭引流技术( vacuum sealing drainage，VSD )及延期组织瓣修复行保肢治疗。创面覆盖后运用外固定支架重建骨缺损或因瘢痕挛缩所致的马蹄畸形。结果8例术后均获得随访，平均22.6个月，且均保肢成功。5例脱套皮肤完全存活，1例大部分存活，足跟处皮肤坏死，跟骨外露，二期经清创交腿皮瓣而愈；5例移植皮瓣均完全存活。骨折及骨缺损患者最终均获得骨性愈合。6例不同程度的马蹄畸形通过外固定支架均得到矫正。结论对于下肢严重毁损伤患者，通过联合运用显微外科技术及外固定支架合理重建骨与大面积软组织缺损，可有效恢复肢体的功能，取得令人满意的结果。“,”Objective To explore the feasibility and curative efficacy of combination of microsurgical technique with external fixator in the management of severely mangled lower extremity including large soft tissue defect, bone loss or exposure, and major vascular injury. Methods From June 2008 to September 2012, 8 patients with severely mangled lower extremity were treated in our hospital. There were 6 males and 2 females with a mean age of 42.6 years old. There were 3 cases of Gustilo III B fractures and 5 cases of Gustilo III C fractures. Fracture location:5 cases in tibiofibula, 3 cases in tibiofibula with metatarsal. After thorough debridement, bone reduction and fixation were performed with temporary external fixator. Injured vessels were repaired by vein transplantation and vascular anastomosis. In-situ remediation was done to repair the large degloving skin. Vacuum sealing drainage ( VSD ) and delayed flap reconstruction were performed for limb salvage. External fixator was used to reconstruct bone defect and treat equines deformity caused by soft tissue contraction. Results The average follow-up was 22.6 months. All 8 patients had their injured limbs saved. Six degloving skins survived completely except one with necrosis in the heel and calcaneous exposure, which was healed by a cross-leg flap. Five flaps survived without any complications. Bone defects and fractures acquired union eventually. Six cases with equines deformities were corrected with external fixator. Conclusions Mangled lower extremity can be successfully salvaged by combination of microsurgical technique and external fixator. Limb function will recover efficaciously followed by the reconstruction of large bone and soft tissue defect.