股前外侧皮瓣修复足跟大面积软组织缺损的感觉重建探讨  

Innervation of free anterolateral thigh flap for repairing widespreadly traumatic soft tissue defects in

作　　者：唐举玉[1] 李康华[1] 谢松林[2] 刘俊[1] 宋达疆[1] 

机构地区：[1]中南大学湘雅医院骨科中南大学骨科研究所,长沙410008 [2]南华大学附属南华医院手外科

出　　处：《中华显微外科杂志》2012年第4期267-271,I0003,共6页Chinese Journal of Microsurgery

基　　金：湖南省卫生厅科研基金资助项目（2005043）

摘　　要：目的探讨股前外侧皮瓣移植修复足跟大面积软组织缺损的感觉重建方法及其临床疗效。方法2005年10月至2010年10月收治足跟大面积软组织缺损25例，依据前期对股外侧皮神经、跟内侧神经和跟外侧神经的解剖和截面形态研究结果，设计、切取股前外侧皮瓣和股外侧皮神经，感觉重建采用股外侧皮神经预制成形与跟内侧神经缝合14例、跟外侧神经缝合2例，采用神经束膜结合外膜缝合法将股外侧皮神经与跟内侧神经缝合3例、跟外侧神经缝合3例，采用小间隙缝合法将股外侧皮神经与跟外侧神经缝合3例，全部病例均选择股外侧皮神经在髂前上棘下5-7cm的平面与跟内和（或）外侧神经起始部缝合。术后测试皮瓣的痛觉、触觉、温度觉和两点辨别觉，了解患者负重、行走功能恢复情况及有无溃疡发生。结果25例股前外侧皮瓣全部成活，修复创面一期愈合。术后随访9-36个月（平均18个月），所有皮瓣恢复保护性感觉，S3＊5例，S3 10例，S210例，感觉恢复优良率为60％，负重和行走能力获得恢复。无一例发生溃疡。结论应用股前外侧皮瓣修复足跟大面积软组织缺损感觉重建时，注意股外侧皮神经的分布及变异情况，选择合适的受区皮神经和吻合部位，依据神经截面的不同形态特点选择合适的神经缝合方法可以明显改善股前外侧皮瓣的感觉功能恢复。Objective To explore new methods of innervating the anterolateral thigh flap（ALTF） for repairing widespreadly traumatic soft tissue defects in heel and report their initial results of clinical application. Methods Twenty-five consecutive ALTFs were transplanted in 25 patients for repairing widespreadly traumatic soft tissue defects in heel from October 2005 to October 2010. Three ways were used in this series for sensory reconstruction of ALTFs, which based on the primary researches of the anatomic and histomorpho- logical characteristics of lateral femoral cutaneous nerve （LFCN）, medial calcaneal nerve （MCN） and lateral calcaneal nerve （LCN）. The first way which was of suture between reshaped LFCN and MCN or LCN was used in 16 cases, the second way which was of perineurial suture combined with epineurial suture was used in 6 cases, and the small-gap-suture way was used in the remaining cases. The section of LFCN 5-7 cm below the anterior superior iliae spine and the initial segment of MCN or LCN were selected as anastomotic position. Postoperative follow-up parameters include pain sensation, touch sensation, thermal sensibility and static two-point discrimination. Results All flaps survived, and the wounds were primary intention. Twenty- five cases followed up 9-36 months （18 months on average）. All flaps restored protective sensation, and the rate of good sensory recovery was 60%. All patients restored weighing and walking, and no ulceration happened. Conclusion Satisfactory sensory function restoration can be obtained by paying attention to the distribution and variety of LFCNs, selecting suitable cutaneous nerves and rational coaptated position as well as suitable suturation means which based on the anatomic and histomorphological characteristics of LFCN, MCN and LCN when repairing widespread soft tissue defects in heel.

关 键 词：股前外侧皮瓣 足跟 感觉重建 修复 皮神经 

分 类 号：R658.3[医药卫生—外科学]