远端蒂腓肠神经营养血管皮瓣近端位置与部分坏死的关系  

Relationship between proximal-tip location and partial necrosis in distally based sural neurofasciocutaneous flap ： an analysis of 157 flaps

作　　者：董忠根[1] 魏建伟[2] 刘立宏[1] 罗顺红[1] 杨洋[1] 周征兵[1] 何苗[1] 邓翔午[1] 

机构地区：[1]中南大学湘雅二医院骨科一病区,长沙410011 [2]湖南省株洲市一医院骨科

出　　处：《中华整形外科杂志》2010年第5期331-336,共6页Chinese Journal of Plastic Surgery

摘　　要：目的探讨远端蒂腓肠神经营养血管皮瓣的近端位置对皮瓣部分坏死的影响。方法回顾性分析2001年4月至2009年5月应用远端蒂腓肠神经营养血管皮瓣转移修复小腿下段及足踝部创面的病例资料，共153位患者157例皮瓣。将小腿后面从外踝尖至胭窝横纹等分为9个区，从下至上依次为第1至第9区。皮瓣分为成活组（包括完全成活、远端表皮坏死和伤口裂开的皮瓣）和部分坏死组；根据皮瓣近端位置，将皮瓣分为近端不超过第6区（A组）、位于第7区（B组）、第8区（C组）和第9区即小腿上1／9区段（D组）4个组。皮瓣采用顺逆结合法切取。结果皮瓣完全成活125例；远端表皮坏死8例，远端伤口裂开6例；远端部分坏死18例（11．5％）。A、B、C和D组皮瓣部分坏死率分别为0（0／19）、2．3％（1／44）、11．3％（7／62）和31．3％（10／32），A组与B组、B组与C组比较，皮瓣部分坏死率的差异均无统计学意义（P〉0．05）；皮瓣部分坏死率：D组高于C组（P=0．012）、近端位于小腿下7／9区域的皮瓣（1．6％，1／63）低于小腿上2／9区域的皮瓣（18．1％，17／94），差异均有统计学意义（P＝0．001）。结论远端蒂腓肠神经营养血管皮瓣的近端不超过小腿下7／9与上2／9交界线时，皮瓣成活可靠；皮瓣近端位于小腿上1／9区段时，皮瓣部分坏死的可能十牛明昂增大。Objective To explore the influence of proximal-tip location on partial necrosis in distally based sural neurofaseiocutaneous flap. Methods From April 2001 to May 2009,157 distally based sural neurofasciocutaneous flaps were conducted to repair the soft tissue defect in distal region of lower leg, ankle and feet in 153 patients. Date of the flaps and the patients were retrospectively analyzed. From the tip of lateral malleolus to the popliteal crease, posterior aspect of the lower leg was equally divided into 9 regions that were 1 st to 9th region from inferiorly to superiorly, respectively. The flaps were divided into 2 groups： survial group（including uneventfully survived flaps, flaps with distally epidermieal necrosis and with wound dehiscence） and partial necrosis group. Based on the location of the proximal tip of flaps, the flaps were stratified into 4 groups ：flaps with the proximal tip locating in the 6th or lower region（ group A）, the 7th region（ group B ）, the 8th region （group C ）and the 9th region （group D ）. Harvesting the flaps started from exploring the perforator of peroneal vessel in the adipofaseial pediele , then the flaps were elevated retrogradely. Results Of the 157 flaps, 125 survived uneventfully,8 showed distal epidermal necrosis,wound dehiscence occurred in 6 flaps,18 flaps（ 11.5% ） showed distal partial necrosis. Partial necrosis occurred in zero of 19 flaps in group A（0）, 1 of 44 flaps in group B （2.3%）, 7 of 62 flaps in group C （ 11.3% ） and 10 of 32 flaps in group D （ 31.3 % ）. The differences in partial necrosis rate between group A and group B ,group B and group C,were not statistically significant （P 〉 O. 05 ）. Partial necrosis rate was higher in group D than in group C（P =0. 012） ,it was lower in group A ＋ group B（ 1.6% ） than in group C ＋ group D（ 18. 1% ） （P = O. 001 ）. Conclusions Distally based sural neurofaseiocutaneous flap can survive reliably when the proxiamal tip of flap is not beyond the junction betw

关 键 词：腓肠神经 外科皮瓣 筋膜蒂皮瓣 危险因素 

分 类 号：R658.3[医药卫生—外科学]