隐神经-大隐静脉营养血管远端蒂复合瓣移植修复小腿、踝足部创伤  

Repair of leg, ankle and foot trauma by using a distally based compound flap pedicled with nutrient vessels of the saphenous nerve-great saphenous vein

作　　者：张发惠[1] 林松庆[1] 张朝春[1] 宋一平[2] 田万成 

机构地区：[1]解放军南京军区福州总医院军区骨科研究所,福建省福州市350025 [2]解放军第九十七医院骨科,江苏省徐州市221004 [3]解放军第一○七医院骨科,山东省烟台市264002

出　　处：《中国组织工程研究与临床康复》2007年第43期8653-8656,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：福建省自然科学基金资助项目(C0510034)~~

摘　　要：目的:在显微解剖学基础上,观察隐神经-大隐静脉营养血管远端蒂复合瓣移植修复小腿、踝足部创伤的临床效果。方法:选择2004-05/2007-04由解放军南京军区福州总医院骨科、解放军第97医院骨科、解放军第107医院骨科采用隐神经-大隐静脉营养血管远端蒂复合瓣移植修复小腿、踝足部组织缺损48例,患者对治疗均知情同意。其中皮瓣修复小腿、踝周及足部的创面感染、缺损23例;肌皮瓣修复小腿上段、下段的溃疡、骨髓炎和骨钢板外露12例,跟骨内侧骨髓炎5例;骨皮瓣修复伴有胫骨缺损和跟骨骨不连的创面8例。术后定期随访,观察隐神经-大隐静脉营养血管远端蒂皮瓣移植修复术后的存活情况及骨皮瓣的骨愈合、功能情况。结果:48例患者术后均有程度不同的皮瓣肿胀,其中3例皮瓣远侧边缘少量坏死,经换药愈合;皮瓣部分坏死植皮1例。伤口Ⅰ期愈合44例,Ⅱ期愈合4例。所有病例经5￣15个月随访,创面及骨不连修复,外形满意。结论:隐神经-大隐静脉营养血管远端蒂皮瓣、复合瓣用于外伤造成的小腿远端骨缺损、骨不连、大的死腔以及踝足部的缺损创面修复,具有快捷方便,抗感染力强,成活率高和愈合快的优点。AIM. To observe the clinical effect of distally based compound flap pedicled with nutrient vessels of the saphenous nerve-great saphenous vein on repairing the injury of leg, ankle and foot. METHODS： Forty-eight patients with the injuries on legs, ankles and feet, who were treated by distally based compound flap pedicled with nutrient vessels of the saphenous nerve-great saphenous vein in the Institute of Orthopedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA, Department of Orthopedics, the 97 Hospital of Chinese PLA, and Department of Orthopedics, the 107 Hospital of Chinese PLA, were selected from May 2004 to April 2007. They were all informed the treatment. Of them, 23 cases of traumatic infection and defect were repaired with flap; 12 cases of ulcer, osteomyelitis and osseous exposure in the inferior segment of leg and 5 cases of interior calcaneal osteomyelitis were repaired with myocutaneous flap; and 8 cases of tibial and calcaneal osseous nonunion repaired with bone （periosteal） flap. All patients were followed up postoperatively to observe the survival condition, bone union and ., functional recovery after operation. RESULTS： The flaps in 48 cases were found swelling at various degrees postoperatively. Of them, a few of the postoperative flaps in 3 cases were necrosis on their distal margins, and healed by repeated dressing changes, and part of the skin grafting flap of 1 case was necrosis. Forty-four cases were of wound healing in 1st stage, while four cases in 4^th stage. All the patients were follow-up for 5 to 15 months, which showed that the traumatic surfaces and osseous nonunion were repaired with satisfactory appearance. CONCLUSION： Distally based pedicled flaps or compound flaps of nutritional vessels of the saphenous nerve-great saphenous vein＇can be used to repair tissue defects caused by trauma, such as bone defects in distal leg, nonunion, large necrotic space as well as traumatic surface of foot and ankle with the advantages of rapidness, convenien

关 键 词：外科皮瓣 隐静脉 腿损伤 踝损伤 组织移植 

分 类 号：R617[医药卫生—外科学]