吻合小隐静脉及腓肠神经的腓肠神经营养血管皮瓣修复足跟部软组织缺损  

Effect of reconstruction venous return and sensation with anastomosis of small saphenons vein and sural nerve to repair tissue defect of heel of foot with surai nerve flap

作　　者：陈添 李兰泉 黄少辉 谢章家 CHEN Tian;XIE Zhang -fia;HUANG Shao -hui(Department of Orthopedics, The Zhanjiang Second People＇s Hospital, Zhanjiang Guang don)

机构地区：[1]湛江市第二人民医院骨外科,广东湛江524000

出　　处：《中国伤残医学》2018年第10期15-17,共3页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的：探讨吻合小隐静脉及腓肠神经重建皮瓣生理性回流及感觉的腓肠神经营养血管皮瓣修复足跟部软组织缺损的临床疗效.方法：2011年12月～2015年12月我科收治13例足跟部不同程度的软组织缺损患者,创面最大面积4×7cm,最小2×3cm,采用腓肠神经营养血管皮瓣所携带的小隐静脉、腓肠神经皮支于显微镜下与足底受区大隐静脉或局部静脉及胫神经或腓浅神经作端端或端侧缝合,重建皮瓣的生理性回流及感觉功能,皮瓣切取面积2×4cm～5×8cm,观察皮瓣成活及功能情况.结果：本组患者均得到随访,随访时间12～30个月（平均15个月）,13例皮瓣全部成活,未出现静脉瘀血、肿胀、张力性水疱及溃疡.术后皮瓣质地良好,外观恢复满意,足感觉及运动功能良好.按照美国足踝外科协会评分系统踝一后足评分系统（总分100分）进行评分,最高得分94分,最低80分,平均90分.按照Glickman-Mackinnon方法评定的皮瓣感觉恢复情况,皮瓣两点辨别觉4～8mm,其中S1级皮瓣9块,S2级皮瓣4块.结论：吻合小隐静脉及重建腓肠感觉神经的逆行腓肠神经营养血管岛状皮瓣修复足部软组织缺损,可明显改善皮瓣回流及保护性感觉功能,减少相关并发症,提高皮瓣成活率及成活质量,临床效果佳.Objectiv： To investigate the clinical effect of repairing tissue defect of heel of foot with sural nerve flap which reconstruct venous return and sensation with anastomosis of the small saphenous vein and sural nerve. Methods： The data of 13 patients of tissue de- fect of heel of foot were retrospectively reviewed, The maximal defect reached 4 - 7cm, and the minimal one was 2 - 3cm. All the patients were treated with sural nerve flap which the small saphenous vein and the Sural nerve was anatomized with the great saphenous vein or an- other branches of vein and superficial peroneal nerve or tibial nerve of the wound under microscope when transferred in order to reconstruct venous return and sensation. The flaps were approximately 2 -4cm -5 -8cm and flap survival and functions were observed. Results： All the patients were followed up 12 -30 months and all the flaps survived, There were no significant venous stasis, swelling, tension blisters and ulceration after the operation, and the texture, shape and function of ankle were satisfactory, the highest score was 94, the lowest score was 80 ,and the average score was 90 according to the ankle -hind foot scoring system. The twopoint discrimination was 4 to 8mm,flap of grade S1 had 9, grade S2 had 5 according to Glickman -Mackinnon method. Conclusion：Treating s tissue defect of heel of foot with Sural nerve flap of anastomosis small saphenous vein and Sural nerve had advantages of improvement venous return and protective sensory , reduction of the correlated complication, promotion of flap survival and quality, which lead to a better clinical outcome.

关 键 词：腓肠神经营养血管皮瓣 小隐静脉 腓肠神经 静脉回流 感觉重建 

分 类 号：R687[医药卫生—骨科学]