跨供区髂骨皮瓣联合感觉神经植入一期修复大面积跟骨与皮肤缺损  

An lilac flap straddling the donor site plus sensory nerve implantation for one-stage repair of massive defects of calcaneai bone and skin

作　　者：刘勇[1] 张成进[1] 付兴茂[1] 王剑利[1] 张雪涛[1] 王蕾[1] 

机构地区：[1]解放军第八十九医院全军创伤骨科研究所,山东省潍坊市261021

出　　处：《中华创伤骨科杂志》2013年第7期571-574,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨利用跨供区髂骨发瓣驳合感觉神经植入一期修复大面积跟骨与皮肤缺损的疗效。方法在对传统髂骨皮瓣进行解剖学研究的基础上，设计以旋髂深动脉为蒂串联旋髂浅动脉的跨供区髂骨皮瓣。自2007年6月至2011年10月应用此皮瓣联合感觉神经植入术一期修复18例大面积跟骨与皮肤缺拟患行，男12例，女6例；年龄18～56岁，平均36岁。跟骨缺损范围平均为7．2cm×2．6cm，皮肤缺损阿积平均为23．0cm×11．0cm结果本组患者大面积跟骨与皮肤缺损均一期修复，皮瓣存活，术后功能外形良好。术后随访1～3年（平均1．8年），足跟部均恢复保护性感觉。术后12个月时，两点辨别觉为16．24mm（平均18．6mm），行走正常，未见溃疡。患足功能据美国足踝外科协会后足功能评分怀准进行评定：优8例，良9例，可1例。结论跨供区改良髂骨皮瓣联合感觉神经植入是一期修复大谢积跟骨与皮肤缺损的良好办法。Objective To study the elinical outcnmes of an lilac flap straddling the donor site plus sensnry nerve implantalion to repair massive detects of calcanea] bone and skin at one stage. Methods Based on anatomical study of the tradition lilac flap, a new iliae flap was designed which straddles the donor site, is pedieled on the deep iliac circumflex artery and links the deep iliac circundlex artelw and the superficial iliac circumflex artery to supply blood. From June 2007 to the October 2011, 18 patients with massive defects of calcaneal hone and skin were treated with our new iliac flap straddling the donor site plus sensory nerve implantation. They were 12 men and 6 women, aged fronl 18 to 56 years （average, 36 years） . The areas of bone defect averaged 7.2 cm× 2.6 cm and the areas of skin defect averaged 23.0 cm× 11.0 cm. Results The massive defeets of calcaneal bone and skin were all repaired with good shape and function at one stage and flaps survived. The patients were followed up for 1 to 3 years after operation （average, 1.8 years） . The protective sensory was recovered well at the heel. One year postoperation, the two-point discrimination ranged from 16 to 24 millimeters （average, 18.6 millimeters） . All patients resumed normal walking and no ulcer occurred. According to the functional assessment system of American Orthopaedic Foot ＆ Ankle Society, 8 cases were excellent, 9 good and one acceptable. Conclusion In repair of massive defects of ealcaneal hone and skin, an iliac flap straddling the donor site plus sensory nerve implantation can result in good clinical outcomes at one stage.

关 键 词：外科皮瓣 跟骨 创伤和损伤 跨供区 感觉神经植入 

分 类 号：R687.3[医药卫生—骨科学]