腓肠神经营养血管皮瓣修复下肢远端软组织缺损的疗效评价  

Clinical Application of Sural Neurocutaneous Flap Retained Perforating Branch to Repair Soft Tissues Defect of Lower Leg,Ankle and Foot

作　　者：谢昀[1] 郑力峰[1] 方心俞[1] 曾锦源[1] 叶君健[1] 

机构地区：[1]福建医科大学第一临床医学院骨科,福州350005

出　　处：《福建医科大学学报》2012年第5期331-334,共4页Journal of Fujian Medical University

基　　金：福建省卫生厅面向农村和城市社区推广适宜技术项目(2010011)

摘　　要：目的介绍保留穿支腓肠神经营养血管皮瓣修复小腿及踝足部软组织缺损的临床经验及手术操作技巧。方法对2006年7月～2011年9月所完成的保留穿支腓肠神经血管营养皮瓣病例进行回顾性调查。临床病例共计74例,男性51例,女性23例,年龄中位数38岁(23～74岁),随访时间平均11月(3～28月)。其中创伤及其并发症导致小腿下段软组织缺损并骨外露28例,胫骨下段慢性骨髓炎并窦道形成7例,小腿下段软组织肿瘤2例,跟骨骨折术后骨髓炎并跟骨外露11例,跟腱断裂修复术后跟腱外露6例,足部软组织缺损并骨外露12例,肌腱外露3例,足跟部皮肤慢性溃疡4例,脂溢性角化病1例。结果皮瓣的临床效果满意,74例中全部成活45例,远端部分表皮坏死11例,伤口愈合延迟6例、远端皮瓣部分坏死9例,其中经换药后自行愈合7例,再次缝合后愈合2例,3例皮瓣大部分坏死,仍有骨质外露,手术失败。皮瓣最大面积为22cm×12cm,最小为7cm×5cm。所有负重区的皮瓣修复皆恢复保护性感觉,负重后无再次发生溃疡。结论保留穿支的腓肠神经营养血管皮瓣相对确保皮瓣的血供,扩大皮瓣的切取面积及修复范围,进一步提高皮瓣的成活率和增加手术成功率。Objective To introduce the clinical experience and surgical technic of the sural neurocutaneous flap retained perforating branch to repair soft tissues defect of lower leg,ankle and foot.Methods Retrospective study were completed on 74 sural neurovascular flaps applied to repair soft tissue defect of the lower leg,ankle and foot between July 2006 to September 2011.51 males and 23 females with a mean age of 38 years old（range from 23 to 74 years） were treated and follow-up from 3 months to 28 months with a mean time of 11 months.Among them,28 cases were soft tissue defect in distal end of lower leg due to trauma and its complications,and 7 cases were chronic osteomyelitis with sinus tract of distal tibia.2 cases were soft connective tissue tumor in distal end of lower leg,and 11 cases were osteomyelitis of calcaneus with exposed plate postoperatively.6 cases were prosthesis of rupture of achilles tendon with exposed tendon,and 15 cases were soft tissue defect of foot with exposed bone（n=12） and muscle tendon（n=3）.4 cases were chronic ulcer of heel,and one case was keratosis seborrheica of heel.Results The clinical outcome was satisfactory ： 45 flaps survived completely;partial distal superficial necrosis took place in 11 flaps;wound healing delayed in 6 cases;distal superficial necrosis took place partially in 9 cases by changing dressings in 7 cases and secondary suturing in 2 cases and achieved healing at last.Mass necrosis in 3 cases showed operation failure.The size of flaps ranged from 7 cm 5 cm to 22 cm 12 cm.All weight area repaired by flap retained sensory recovery so that none ulcer took place after weight loading.Conclusion The perforating branch should be reserved to enlarge the size of the flap and combining part of gastrocnemius muscle could be used to repair a deep defect.In the research,the applied range of the flap was enlarged and it can be used to repair soft tissue defect easily.

关 键 词：外科皮瓣 腓肠神经 血管 营养生理学 软组织损伤 

分 类 号：R658.3[医药卫生—外科学]