皮岛倾斜设计的远端蒂腓肠神经筋膜皮瓣修复胫前纵向或跟踝部横向创面  

SURAL NUEROFASCIOCUTANEOUS FL AP WITH SLOPE-DESIGNED SKIN ISLAND FOR COVERAGE OF SOFT TISSUE DEFECTS LONGITUDINAL IN DISTAL PRETIBIAL REGION OR TRANSVERSE IN HEEL AND ANKLE

作　　者：董忠根[1] 刘玺[1] 刘立宏[1] 魏建伟[1] 彭平[1] 彭新宇[1] 

机构地区：[1]中南大学湘雅二医院骨科,长沙410011

出　　处：《中国修复重建外科杂志》2016年第11期1391-1395,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金青年基金项目(81401803);湖南省科技厅科技计划项目(2014 TT 2016)~~

摘　　要：目的介绍远端蒂腓肠神经筋膜皮瓣修复小腿下段胫前纵向创面或跟踝部横向创面时皮岛倾斜设计的改良技术,并总结其临床疗效。方法 2001年4月-2016年1月,对37例(38处)小腿下段胫前纵向或跟踝部横向皮肤软组织缺损采用皮岛倾斜设计的远端蒂腓肠神经筋膜皮瓣修复。男28例,女9例;年龄5~78岁,中位年龄37岁。小腿下段胫前纵向创面11处,创面横向长度为3~8 cm、纵向长度为8.5~14.5 cm;跟踝部横向创面27处,创面横向长度为9~21 cm、纵向长度为3.0~10.5 cm。病程2 d^5年。结果 25例皮瓣常规设计时,皮岛范围超过了内侧界限(胫骨内侧缘)或外侧界限(腓骨前缘)。皮岛倾斜设计后,皮岛横向长度较常规设计时减少2.5~14.8 cm,平均5.4 cm;纵向长度增加2~15 cm,平均5.3 cm。皮岛旋转角为42~90°,平均67°。术后35个皮瓣完全成活,创面Ⅰ期愈合;2个皮瓣发生边缘坏死,1个皮瓣发生远端部分坏死。皮瓣部分坏死发生率为2.6%(1/38)。供区植皮均成活,切口均Ⅰ期愈合。患者均获随访,随访时间6~42个月,平均10个月。随访期间无感染复发及溃疡,患者对皮瓣外观满意。末次随访时根据Boyden等评价标准评定皮瓣重建肢体功能,获优30处,良6处,可2处,优良率为94.7%。结论选择远端蒂腓肠神经筋膜皮瓣修复小腿下段胫前纵向创面或跟踝部横向创面时,皮岛倾斜设计可缩短皮岛横向长度,提高皮瓣成活率,扩大皮瓣适用范围。Objective To introduce a modified technique of a sloped skin island design for the distally based sural nuerofasciocutaneous flap to reconstruct soft tissue defects longitudinal in distal pretibial region or transverse in the heel and ankle, and report the effectiveness of the modified technique. MethodsBetween April 2001 and January 2016, 37 patients （38 defects） with longitudinal defects in distal pretibial region or transverse defects in the heel and ankle were treated with the sural nuerofasciocutaneous flap with slope-designed skin island. These patients included 28 males and 9 females, with a median age of 37 years （range, 5-78 years）. The horizontal and vertical dimensions ranged from 3 to 8 cm and 8.5 to 14.5 cm in 11 distal pretibial defects, and from 9 to 21 cm and 3.0 to 10.5 cm in 27 heel and ankle defects, respectively. The disease duration ranged from 2 days to 5 years. ResultsWhen the skin islands were routinely designed, the skin islands of 25 flaps would exceed the lateral limit （the anterior border of the fibula） laterally or medial limit （the medial border of the tibia） medially. After the skin islands were obliquely designed, the horizontal dimensions in 38 flaps decreased an average of 5.4 cm （range, 2.5 to 14.8 cm）, and the vertical dimensions increased an average of 5.3 cm （range, 2 to 15 cm）. The rotation angles ranged from 42° to 90°, with an average of 67°. Thirty-five flaps survived uneventfully. Margin necrosis occurred in 2 flaps, and partial necrosis in 1 （2.6%） flap. The grafted skins at donor site survived, and primary healing of incision was obtained. All patients were followed up 6 to 42 months （mean, 10 months）. No infection or ulceration was noted during the follow-up period, and the appearances of the flaps were satisfactory. At last follow-up, according to Boyden et al criteria, the limb function was excellent in 30 cases, good in 6 cases, and poor in 2 cases, with the excellent and good rateof 94.7%. ConclusionWhen the distal sural nuerofas

关 键 词：腓肠神经筋膜皮瓣 小腿 足踝 创面修复 改良设计 

分 类 号：R658.3[医药卫生—外科学]