矩形推进皮瓣修复儿童跟腱周围皮肤缺损  

Reconstruction of skin defects around the Achilles tendon with rectangle advancement flap in children

作　　者：刘阳[1] 赵吉堂 田书委 宋连新[1] 吴春生[1] 彭阿钦[1] 张彦龙[1] 

机构地区：[1]河北医科大学第三医院创伤急救中心河北省骨科研究所河北省骨科生物力学重点实验室,石家庄050051

出　　处：《中华创伤骨科杂志》2017年第6期537-539,共3页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨应用矩形推进皮瓣修复儿童足跟部皮肤缺损的方法及疗效。方法回顾性分析2014年5月至2015年6月收治的7例儿童跟腱周围皮肤缺损的患儿资料，男4例，女3例；平均4．3岁；皮肤缺损面积为3．4cm×2．7cm～5．5cm×4．0cm；有1例患者跟腱在止点处部分断裂，其余6例患者跟腱保持完整。清创后采用自行设计的矩形推进皮瓣修复足跟部皮肤缺损。跟腱部分断裂者先将有污染的残端切除，再闭合伤口。术后为降低皮瓣的张力，用1枚1．5mm克氏针将踝关节固定于跖屈位并用石膏托保护。结果术后皮瓣全部成活，有2例患儿伤口局部感染，经换药后愈合，其余伤口愈合良好。随访时间8～12个月（平均11．5个月），有2例患儿伤口瘢痕较明显，其余患儿皮瓣色泽、质地与周围组织接近，踝关节功能皆正常。结论矩形推进皮瓣操作简单、安全可靠，是修复儿童跟腱周围皮肤缺损的有效方法。Objective To explore the clinical efficacy of rectangle advancement flaps used in the reconstruction of skin defects around the Achilles tendon in children. Methods From May 2014 to June 2015, 7 children with skin defects around the Achilles tendon were admitted to our trauma center. The areas of skin defect ranged from 3.4 cm× 2.7 cm to 5.5 cm × 4.0 cm. The integrity of Achilles tendon was preserved in 6 cases but the tendon insertion was partly disrupted in one case. The skin defects were reconstructed with self-designed rectangle advancement flaps after debridement. In the one case with the Achilles tendon partly disrupted, the contaminated tendon ends were excised before wound closure. The injured ankles were immo- bilized in plantar flexion with one 1.5 mm K-wire and plaster splint to decrease the postoperative tension of the flap. Results All the flaps survived completely by primary intention but local infection occurred in 2 wounds which was cured by second intention of dressing change. The follow-up periods ranged from 8 to 12 months （average, 11.5 months）. The scar around the flap was remarkable in 2 cases, but the flaps in the other cases appeared normal in terms of color and texture. The ankle function was satisfactorily normal in all the cases. Conclusion Our self-designed rectangle advancement flaps provide a simple, safe and reliable way to repair skin defects around the Achilles tendon in children.

关 键 词：足 创伤和损伤 外科皮瓣 儿童 

分 类 号：R726.8[医药卫生—儿科]