跟后软组织缺损的简便修复  

The Convenient Reparation of Heel Tissue Defects

作　　者：左宗宝[1] 李小静[1] 宁金龙[1] 张林[1] 朱飞[1] 高学宏[1] 

机构地区：[1]安徽医科大学第一附属医院整形外科,安徽省合肥市230022

出　　处：《组织工程与重建外科杂志》2007年第5期260-263,共4页Journal of Tissue Engineering and Reconstructive Surgery

摘　　要：目的探讨不同面积、不同深度足跟后软组织缺损的新的、简便、有效的修复方法。方法根据跟后缺损面积及病变性质,设计两种简便方法对其进行修复。设计带薄层肌肉腓肠神经-小隐静脉营养血管远端蒂岛状皮瓣修复大面积足跟后深度软组织缺损,修复最大缺损面积12cm×9cm;另于小腿下段,设计腓骨肌腱鞘筋膜瓣与脂肪筋膜瓣联合转移覆盖中、小面积跟后软组织缺损,在其上移植全厚皮片或中厚断层皮片,修复最大缺损面积6cm×4cm。结果⑴自2004年1月～2006年12月以来,在传统腓肠神经营养血管远端蒂岛状皮瓣设计的基础上,切取携带薄层(0.5～1.5cm)厚度,且小于皮瓣表面积的肌肉瓣,临床应用5例,修复足跟后、底部大面积软组织缺损,皮瓣最大18cm×12cm,最小12cm×7cm。带薄层肌肉皮瓣血运丰富,所有皮瓣均完全成活,伤口一期愈合,经2～24个月随访,足跟功能、外形恢复满意;⑵自2004年1月～2007年4月,应用腓骨肌腱鞘筋膜与脂肪筋膜联合瓣修复跟后软组织缺损7例,最大筋膜瓣6cm×13cm。术后转移筋膜瓣及移植皮片完全存活。随访3～13个月,供受区稳定愈合,功能、形态恢复满意。结论带薄层肌肉腓肠神经营养血管远端蒂岛状皮瓣,血运丰富,抗感染力强,皮瓣修复面积大,且能增加足底软组织骨垫厚度,增强耐磨性,是大面积足跟后、底部深度软组织缺损较为的理想选择方法。腓骨肌腱鞘筋膜瓣或与脂肪筋膜瓣联合转移加皮片移植法,就近取材,供区病损小,鞘筋膜瓣柔韧滑润,覆盖跟腱与组织层厚度相似,是跟后中﹑小面积缺损的可靠修复方法。两种新手术方法均操作简便,术时短,安全可靠。Objective To explore the repairing methods and effect about different area and depth heel tissue defects. Methods On the basis of heel tissue defects area and character, we designed sural neurofasciocutaneous island flap along with lamellar muscle,to repair a large area heel tissue defects, maximum area 12 cm ~ 9 cm; Another at lower crus peroneal tendofascial flap or conjoined with fat fascial flap were designed, to repair a small area heel tissue defects, maximum area 6 cm × 4 cm, and full-thickness free skin graft or middle-thickness free skin graft were grafted on flap. Results （1） From Jan 2004 to Dec 2006, based on the original design of sural neurofasciocutaneous island flap, we dissect the flap take along with lamellar muscle which thickness within 0.5~1.5 em, and is smaller than the surface area of the flap. 5 cases have been treated with this method, to repair a large area heel tissue defects, maximum flap 18 cm ~ 12 cm, minimum flap 12 cm ~ 7 cm. All flaps survived completely and the wounds healing synchronized. All cases were followed up from 2-24 months, outline satisfied, and function well; （2） From Jan 2004 to Apr 2007, 7 patients suffered from heel tissue defects had been treated with peroneal tendofascial flap or conjoined with fat fascial flap. the largest is 6 cm × 13 cm. All fascial flaps and free skin grafts successfully survived after operations. All patients were followed 3-23 months, the operation area were healed and function and configuration were much satisfied. Conclusion Blood supply of the neuroadipofascial pedieled based sural island myofascialcutaneous flap is reliable and the lamellar muscle improve the its anti-infection ability, it＇s profit for the healing of bone infection and fracture, which is effective way for repairing of the large tissue defects of heel. peroneal tendofascial flap conjoined with adipofasical flap and free skin graft are used to repair heel deep tissue defects,which is a handy, dependable way for repairing of the small tissue defects of heel. Th

关 键 词：跟后 缺损 修复 

分 类 号：R622[医药卫生—整形外科]