邻近逆行穿支带蒂双皮瓣修复足部贯通伤的临床疗效  

Clinical effectiveness of double adjacent perforator flaps with pedicle for repairing penetrating wound of feet

作　　者：郑润泉[1] 邹林[2] 陈晨[2] 曹学成[2] 张贵春[2] ZHENG Runquan;ZOU Lin;CHEN Chen;CAO Xuecheng;ZHANG Guichun(Taishan Medical University, Taian 271000, China)

机构地区：[1]泰山医学院研究生部,山东泰安271000 [2]济南军区总医院骨创伤外科,济南250031

出　　处：《骨科》2017年第1期12-15,共4页ORTHOPAEDICS

摘　　要：目的探讨邻近逆行穿支带蒂双皮瓣修复足部贯通伤的治疗经验及临床疗效。方法2010年1月至2014年7月,我科收治9例足部贯通伤病人,伤足均有不同程度的两侧软组织缺损,早期彻底清创、止血,大量液体冲洗下负压封闭引流覆盖创面,择期以邻近逆行带蒂腓肠神经营养血管皮瓣和内踝上皮瓣一次性修复两侧皮肤软组织缺损。术后观察皮瓣存活情况,并采用美国足踝外科医师协会(AOFAS)踝与后足功能评分系统评价伤足的恢复情况。结果术后2例皮瓣边缘坏死,分别经换药和植皮后成活;1例外侧皮瓣创口长时间渗液,经换药引流,4周后愈合;其余病人皮瓣均顺利成活,供区创面一期愈合。本组9例均获随访,病人对其外形、色泽、厚度可接受。AOFAS踝与后足功能评分系统评价均为优。结论邻近逆行穿支带蒂双皮瓣是修复足部贯通伤的有效方法,围手术期处理使污染创面变成相对清洁创面是皮瓣成功的基础条件,合理选择、设计皮瓣,深筋膜充分填塞创腔是治疗成功的关键。Objective To explore the treatment methods and clinical effectiveness of double adjacent perforator flaps with pedicle for repairing penetrating wound of feet. Methods Between January 2010 and July 2014, 9 patients with penetrating wound of feet were surgically treated in our hospital. The feet had different degrees of bilateral skin and soft tissue defects. After debridement, hemostasis, flushing, and drainage with VSD technology, penetrating wound of feet was repaired with sural neurouascular and medial supramalleolar perforator flaps with pedicle in a one?stage procedure. The flap survival conditions were observed after opera?tion, and the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system was used to evaluate therecovery of the affected feet. Results Two cases had partial skin necrosis at the distal site: one case healedafter dressing, and the other healed after applying additional dermoplasty. In another case, flap blood supplywas good, but the wound was continuous discharging, which was healed through dressing and drainage over4 weeks. The rest of the flaps survived, as well donor wounds primarily healed. All cases were followed up, andthe satisfaction rate of patients was 100% in its shape, color and thickness. Conclusion Double adjacentperforator flaps with pedicle for repairing penetrating wound of feet could achieve better outcomes, and had preferable value in clinical application. Perioperative treatment that making the contaminated wound into relatively clean wound was the basis of the flap survived, and reasonable design of skin flap, and fully filling of cavity in the deep fascia were the key to the success of the treatment.

关 键 词：足 创伤 贯通性 软组织损伤 外科皮瓣 修复 

分 类 号：R658.3[医药卫生—外科学]