远端蒂隐神经营养血管肌皮瓣修复踝足部软组织缺损  

Clinical Application of Distally Based Saphenous Neurocutaneous Vascular Myocutaneous Flap for Repairing the Soft Tissue Defect in Foot and Ankle

作　　者：何锡彬[1,2] 喻爱喜[1] 祝少博[1] 陶圣祥[1] 潘振宇[1] 

机构地区：[1]武汉大学中南医院显微骨科,湖北武汉430071 [2]江苏省姜堰市人民医院骨科,江苏姜堰225500

出　　处：《武汉大学学报（医学版）》2009年第4期526-529,共4页Medical Journal of Wuhan University

基　　金：湖北省科技厅攻关项目(编号:2007AA301B37-1)

摘　　要：目的:探讨远端蒂隐神经营养血管肌皮瓣在修复踝足部特殊病例的软组织缺损中的临床应用。方法:应用远端蒂隐神经营养血管肌皮瓣修复踝足部特殊病例的软组织缺损16例,其中男性12例,女性4例,年龄14-57岁。跟骨慢性骨髓炎伴内踝处软组织缺损1例,踝部及足跟部软组织缺损伴死腔形成7例,足底部软组织缺损伴跟骨缺损8例。创面范围:3 cm×5 cm至9 cm×13 cm。肌皮瓣面积:4 cm×6 cm至11 cm×15 cm。携带腓肠肌的厚度1-4 cm。结果:本组16例远端蒂隐神经营养血管肌皮瓣全部成活,仅1例肌皮瓣远端稍肿胀青紫,有少许张力性水泡形成,经拆除缝线减张、换药2周愈合。所有病例均经3个月以上随访,骨髓炎治愈,肌皮瓣外形满意,行走负重良好,供区未见明显功能障碍。结论:远端蒂隐神经营养血管肌皮瓣血供可靠,不牺牲主要血管,是修复踝足部特殊病例的软组织缺损的良好供区。Objective： To investigate the clinical application of distally based saphenous neurocutaneous vascular myoeutaneous flap for repairing the soft tissue defect in foot and ankle in special eases. Methods： From Jan 2005 to Jan 2008, distally based saphenous neurocutaneous vascular myocutaneous flap was applied for repairing the soft tissue defect in foot and ankle in 16 special cases （12 male cases, aged from 14 to 57 years） as following： chronic osteomylitis of calcaneus accompanied by soft tissue defect of medial malleolus in one case, soft tissue defect of ankle and heel accompanied by dead space in 7 cases, and soft tissue defect of sole of foot accompanied by bone loss of calcaneusin8 cases. The area of wound ranged from 3.0 cm 5.0 cm to 9.0 cm 13.0 cm, the scope of the flap was 4.0 cm×6.0 cm to 11.0 cm×15.0 cm, and the thickness of gastrocnemius flap was 1.0-4.0 cm. Results： All the 8 distally based saphenous neurocutaneous vascular myocu-taneous flaps survived. All these cases were followed up at least for 3 months and had significant outcomes of nice musculocutaneous flap shape, cured osteomyelitis, and satisfaction in walking and weight loading. No obvious functional disability has been found in the flap providing area. Conclusion： Distally based saphenous neuroeutaneous vascular myocutaneous flap has abundant blood supply without destroying the major arteries, the flap is simple to prepare and can survive easily for repairing the soft tissue defect in foot and ankle in special cases.

关 键 词：隐神经 大隐静脉 肌皮瓣 

分 类 号：R622.1[医药卫生—整形外科]