以远端穿支血管为蒂的皮神经营养血管逆行皮瓣修复小腿和足踝部软组织缺损  

The repair of soft tissue defect in lower leg and ankle region using retrograde neurocutaneous flaps pedicled distal perforating branch blood vessel

作　　者：沈尊理[1] 黄一雄[1] 贾万新[1] 蔡娴[1] 黄燮青[1] 章开衡[1] 张兆峰[1] 沈华[1] 王永春[1] 林森[1] 

机构地区：[1]上海交通大学附属第一人民医院整形外科,上海200080

出　　处：《中国美容整形外科杂志》2008年第6期419-422,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的探讨以远端穿支血管为蒂的皮神经营养血管逆行皮瓣修复小腿和足踝部软组织缺损的皮瓣选择,技术要点和临床疗效。方法采用以腓动脉穿支为远端蒂的腓肠神经营养血管逆行皮瓣修复小腿下端、足跟负重部与足踝前侧或外侧创面16例,以胫后动脉穿支为远端蒂的隐神经营养血管逆行皮瓣修复足跟内侧创面6例,以胫前动脉穿支为远端蒂的腓浅神经营养血管逆行皮瓣修复足踝前侧或内侧创面3例。创面面积3.0cm×3.5cm～8.5cm×9.0cm。结果所有皮瓣均存活,2例远端静脉回流障碍,经换药后痊愈。1例皮瓣远端伤口裂开,重新缝合后痊愈。25例获随访8个月至5年,发现皮瓣外形满意,具有保护性感觉,无磨损破溃,患者穿鞋行走正常。结论以腓动脉、胫前动脉或胫后动脉穿支为远端蒂的神经营养血管皮瓣血供可靠,方法简单,不牺牲主干血管,是修复小腿和足踝部软组织缺损的良好方法。避免皮瓣张力是保证皮瓣成活的关键。Objective To explore the flap selection and operation tricks of flap devadon as well as clinical results of various retrograde neurocutaneous flaps pedicled distal perforating branch blood vessel which were used to reconstruct the soft tissue defects in foot and lower leg region. Methods Twenty - five cases were included in this group with an average age of 61, in which the soft tissue defects were resulted from tumor resection, trauma, infection and burn injuries. The dimension of soft tissue defects ranged from 3.0 cm × 3.5 cm to 8.5 cm × 9.0 cm in foot and lower leg region. The ankle, heel and lateral side of foot were repaired by sural neturocutancous flaps based on the distal peroneal perforators in 16 cases. The soft-tissue defects in the medial side of foot were covered by saphenous neurocutaneons flaps based on the distal perforators of posterior tibial artery in 6 cases. The soft- tissue defects located in the anterior - medial side were repaired by superficial peroneal neurocutancous flaps based on the distal perforators of anterior tibial artery in 3 cases. Results All flaps survived, however, a distal venous congestion occurred in 2 cases and the wound healing was achieved after dressing change. In addition, a wound dehiscence happened after early weight - bearing walk and subsequently treated by a secondary suture. The follow - up duration ranged from 8 months to 5 years. All patients were satisfied with the flap appearance. There was a protective sensibility in all flaps without abrasion or ulceration. The walking pattern was as normal as before. Conclusion It is a reliable approach to reconstruct the soft - tissue defect in lower lag and foot region using neurocutaneous flaps based on distal perforators of peroneal artery, anterior tibial artery and posterior tibial artery, respectively. The advantages include simply procedures, reliable blood supply without sacrificing main arteries. Avoidance of flap tension is the key point for flap survival.

关 键 词：外科皮瓣 皮神经 足 小腿 

分 类 号：R658.3[医药卫生—外科学]