胫后动脉穿支皮瓣修复足后肌腱外露改善肌腱愈合25例的临床观察  

The clinical observation of ultilizing subemergency posteriror tibia perforator flaps towards repairing the open wounds of heel injuries while reserving exposured degenerative tendon

作　　者：罗昭和 唐修俊 邓呈亮 魏在荣 王达利 Luo Zhaohe;Tang Xiujun;Deng Chengliang;Wei Zairong;Wang Dali(Department of Burns and Plastic Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou563099,China)

机构地区：[1]遵义医科大学附属医院烧伤整形外科,贵州遵义563099

出　　处：《遵义医学院学报》2019年第2期210-213,共4页Journal of Zunyi Medical University

基　　金：国家自然科学基金资助项目(NO:81560313);贵州省科技计划项目(NO:黔科合SY字[2012]3084);遵义市汇川区科技计划项目(NO:遵汇科合[2015]25)

摘　　要：目的探讨应用胫后动脉穿支皮瓣带蒂转移亚急诊修复伴有肌腱外露和肌腱变性足外伤的整复效果。方法收集2013年8月到2016年8月遵义医科大学附属医院烧伤整形外科急诊及骨科足后开放性外伤伴肌腱外露病例25例,男21例,女4例,入院后经急诊清创后保留仍有弹性的肌腱,负压封闭引流(VSD)持续保护创面,亚急诊二期手术再次扩创后切取胫后动脉穿支皮瓣带蒂转移修复,皮瓣成活后出院并长期随访肌腱恢复程度及效果。结果 25例患者通过转移皮瓣修复创面,患者外露肌腱均得以保留,术后肌腱粘连6例,其余病例无肌腱粘连,皮瓣均成活。结论应用亚急诊胫后动脉穿支皮瓣带蒂修复对受损变性的跟腱肌腱治疗有积极的作用,可降低患者致残率及恢复时间,提高修复效果,改善预后及生活质量。Objective To investgate the curing effect about using the posteriror tibia perforator flaps to repair the open injuries of heel which within tendon exposed after the successful debridement meanwhile reserved incomplete necrosis degenerative tendon(Standard:elastcity of tendon’s still remained).Methods The treatment group had collected 25 cases(21 males and 4 females) within open wounds of heel which had local tendon exposured and bruised.Treated with transfer posteriror tibia perforator flap after the suscessful debridment while kept the incomplete necrosis degenerative tendon,the Time-window was from August,2013 to August,2016 in Burn and Plastic Surgery of Affiliated Hospital of Zunyi Medical University After emergency debridment and before the Subemergency flap sugury.The recipient area was protected by aseptic bioflim and VSD.During the surgical operation,the posteriror tibia perforator flaps were suscessfully incised out,then pedicle transfered to cover the recipient area.Then observed the prognosis of flaps and recovering results of exposure degenerative tendon by follow-up visit.Results All flaps survived according to the follow-up visit with half a year after operations.Degenerative tendon of all patients finally remained.The tendon adhesion occurred in 6 patients and others were healed well and all flaps survived.Conclusion This study confirms the treatment of flap in repairing the open wounds of heel injuries with inspiring consequence.The flow-up visit also shows that the reserved degenerative tendon could be healed toward recover functionality by rebuilding the blood supply around wound area.

关 键 词：足外伤 胫后动脉穿支皮瓣 肌腱外露 变性肌腱 创面修复 

分 类 号：R622.1[医药卫生—整形外科]