腓肠神经小隐静脉筋膜皮瓣在跟腱周围皮肤与软组织恶性肿瘤切除术后修复中的应用  

Sural neuro-lesser saphenous fasciocutaneous flap for defect reconstruction after radical excision of the skin and soft tissue malignant tumors around Achilles tendon

作　　者：金谷[1] 贾东东[1] 李涛[1] 钱文康[1] JIN Gu;JIA Dong - clong;LI Tao;QIAN Wen - kang(Bone and soft tissue tumor surgery, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang, China)

机构地区：[1]浙江省肿瘤医院骨与软组织肿瘤外科,浙江杭州310022

出　　处：《广东医学》2018年第12期1810-1814,共5页Guangdong Medical Journal

基　　金：浙江省医药卫生科技计划项目(编号:2017KY024)

摘　　要：目的探讨应用腓肠神经小隐静脉筋膜皮瓣修复跟腱周围皮肤与软组织恶性肿瘤切除术后皮肤软组织缺损的疗效。方法回顾性分析21例跟腱周围皮肤与软组织恶性肿瘤初治患者的临床资料,结合术前MR和病理,规范化行恶性肿瘤的根治性切除,皮肤软组织缺损范围为6.0 cm×4.0 cm^8.0 cm×6.0cm。所有病例的皮肤与软组织缺损均采用腓肠神经小隐静脉筋膜皮瓣修复缺损,术前常规多普勒明确腓动脉最低肌间隔穿支位置,把腓肠神经体表投影作为轴心线并以小隐静脉营养血管为蒂设计适合缺损范围的筋膜皮瓣,逆行转位覆盖创面。结果 21例皮瓣除1例因静脉淤血发生远端1/3坏死,余20例皮瓣均完全成活,远期全部皮瓣色泽优良,外观臃肿不明显,质地柔软耐磨,穿鞋行走及提踵无受限。所有病例均无局部复发,1例透明细胞肉瘤和1例皮肤恶性黑色素瘤因转移死亡,余随访至今。结论腓肠神经小隐静脉筋膜皮瓣是修复跟腱周围皮肤与软组织恶性肿瘤切除术后缺损的理想方法。Objective To investigate the effect of sural neuro - lesser saphenous fascioeutaneous flap on reconstruction of skin and soft tissue defects after resection of skin and soft tissue malignant tumors around Achilles tendon. Methods We retrospectively analyzed the clinical data of 21 patients with malignant tumors of skin and soft tissue around Achilles tendon. According to MR and pathology, standardized radical resections of malignant tumors were performed, and the skin and soft tissue defects ranged from 6. 0 cm × 4. 0 cm to 8.0 cm × 6. 0 cm. In all cases, defects were reconstructed with the sural neuro - lesser saphenous fasciocutaneous flap. The perforator vessels were located by preoperative Doppler ultrasound and the sural nerve was used as the central axis of the flap. Flaps with the distal pedicle of the perforator vessels were designed to reconstruct the defects. Results Of the 21 flaps, one had distal necrosis due to venous congestion and 20 survived uneventfully. All of these flaps had an excellent color and a soft texture and were wear - resistant with no obvious swelling. There was no limit in walk and heel lifting in all cases. No local recurrence was found in all cases. One case of transparent cell sarcoma and 1 case of malignant melanoma of the skin died of metastasis. Conclusion The sural neuro - lesser saphenous fasciocutaneous flap is ideal to cover the defects after the resection of the skin and soft tissue malignant tumors around Achilles tendon.

关 键 词：跟腱 腓肠神经小隐静脉筋膜皮瓣 皮肤与软组织恶性肿瘤 

分 类 号：R738[医药卫生—肿瘤]