带隐神经的小腿内侧皮瓣修复足踝部骨外露  

Medial crus skin flap with Saphenous nerve to repair the bone exposure of the ankle and foot

作　　者：陈佳 杨鹏飞[2] 龙兴敬 杨世林 匡安银 代羽 CHEN Jia, YANG Pengfei, LONG Xingjin, et al(Department of Orthopedics, The People＇s Hospital of gaoxin District, Chongqing, 400039, Chin)

机构地区：[1]重庆市高新区人民医院骨科,重庆400039 [2]第三军医大学西南医院关节外科中心,重庆400038

出　　处：《实用手外科杂志》2018年第1期46-48,共3页Journal of Practical Hand Surgery

摘　　要：目的探讨带隐神经营养血管的小腿内侧皮瓣修复足踝部骨外露的临床疗效。方法 2004年10月-2016年5月,采用带隐神经营养血管的小腿内侧皮瓣修复足踝部骨外露26例。软组织缺损范围4.0 cm×3.0 cm^11.0 cm×8.5 cm,皮瓣切取范围5.5 cm×3.5 cm^12.5 cm×10.0 cm。术后石膏制动,抗炎、抗凝、解痉等处理,2周后拆石膏行功能锻炼。结果 26例均获随访6~48个月,平均24个月。术后21例伤口Ⅰ期愈合,植皮及皮瓣完全成活,完全恢复正常行走;4例皮瓣远端部分坏死,经清创及换药治疗伤口Ⅱ期愈合,较好地恢复行走;1例皮瓣大部分坏死,经交腿皮瓣治疗伤口愈合,轻度跛行步态。结论带隐神经的小腿内侧皮瓣具有解剖位置恒定、操作简单可靠、皮瓣成活率较高、功能恢复优良的优点,是修复足踝部骨外露的理想皮瓣之一。Objective To discuss the clinical effect of the medial crus neurocutaneous skin flap with Saphenous nerve on repairing the bone exposure of the ankle and foot. Methods We transfered the medial crus neurocutaneous skin flap with Saphenous nerve to treat the bone exposure of the ankle and foot for twenty-six cases from October 2004 to May 2016, 17 males and 9 females, aged 14 to 65 years old, 14 cases in the right side while 12 cases in the left side. The range of the defect was from 4.0 cm×3.0 cm to 11.0 cm×8.5 cm, and the flap from 5.5 cm×3.5 cm to 12.5 cm×0.0 cm. The immobihzation anti- infection, anticoagulation and spasmolysis were needed,following the functional exercise 2 weeks later. Results Twenty-six cases were followed up for 6-48 months, an average of 24 months. The postoperative wound of 21 cases got primary healing, the flaps survived completely, and the patients recovered to normal walking completely. 4 cases had distal flap necrosis, which healed after dressing and debridement, and the patients recovered walking. 1 flap necrosed entirely, but the wound healed by cross leg flap, following the mild limping gait. Conclusion Medial crus skin flap with Saphenous nerve is one of the ideal choices to treat the bone exposure of the ankle and foot, with constant anatomical location, simple and reliable operation, high survival rate, and functional recovery with good appearance.

关 键 词：隐神经 小腿内侧皮瓣 足踝 骨外露 

分 类 号：R658.3[医药卫生—外科学]