远端蒂腓肠神经营养血管皮瓣的应用及静脉淤血的预防处理  

Application of distally based sural nerve nutritional vessel flap and prevention and treatment of venous congestion

作　　者：吴晓通 展望[1] 游文健[1] 林遐[1] 刘韵[1] 高飞 王佳瑶 WU Xiao-tong;ZHAN Wang;YOU Wen-jian;LIN Xia;LIU Yun;GAO Fei;WANG Jia-yao(Department of Plastic Surgery,Hainan General Hospital,Haikou 570311,China)

机构地区：[1]海南省人民医院整形外科,海南海口570311

出　　处：《中国美容整形外科杂志》2020年第11期669-671,共3页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的 探讨远端蒂腓肠神经营养血管皮瓣修复足踝部软组织缺损的临床疗效及出现静脉淤血的预防和处理方法。方法 自2014年7月至2018年7月,采用远端蒂腓肠神经营养血管皮瓣修复足踝部软组织缺损患者21例,皮瓣面积为7 cm×4 cm^15 cm×8 cm。旋转点位于外踝上5~7 cm,蒂部筋膜宽度3~6 cm,保留部分皮桥,并于旋转点附近选择性结扎蒂部小隐静脉,采用明道转移,供区直接闭合或植皮。结果 术后21例皮瓣均成活,其中2例出现远端局部表层皮肤坏死,经积极换药治疗后瘢痕愈合,余19例未见明显静脉淤血、肿胀现象。随访9~16个月,所有患者足踝部缺损处修复良好,皮瓣外观及质地较好。结论 采用远端蒂腓肠营养血管皮瓣修复足踝部软组织缺损是较理想的术式,尤其当伴有肌腱、骨骼外露时;保证蒂部足够宽度及选择性在旋转点附近结扎小隐静脉可有效改善该皮瓣静脉淤血。Objective To explore the clinical efficacy of distally based sural nerve nutritional vessel flap in the repair of foot and ankle soft-tissue defects and prevention and treatment of venous congestion. Methods From July 2014 to 2018, 21 patients with soft tissue defects in foot and ankle were repaired by distally based sural nerve nutritional vessel flaps. The area of flap ranged from 7 cm × 4 cm to15 cm × 8 cm. The rotation point was located on 5 to 7 cm of the lateral malleolus. The width of pedicle fascia was from 3 to 6 cm. Partial skin bridge was reserved and small saphenous vein near the rotation point was selective ligated. The open tunnel transfer was adopted. The donor sites were directly closed or covered by split-thickness skin grafts. Results All of the 21 flaps survived. Distal local necrosis of skin surface occurred in 2 patients and the scar healed after dressing change. No obvious venous congestion and swelling occurred in remaining19 patients. After 9 to 16 months of follow-up, all defects in foot and ankle were repaired well. The appearance and texture of flaps was good. Conclusion The distally based sural nerve nutritional vessel flap is an ideal surgical option in the repair of foot and ankle soft-tissue defects, especially accompanied with tendon and bone exposure. The venous congestion of flap could be effectively improved by ensuring a certain width of pedicle and selectively ligating the small saphenous vein near the rotation point.

关 键 词：腓肠神经营养血管皮瓣 静脉淤血 小隐静脉 足踝部 软组织缺损 

分 类 号：R658.3[医药卫生—外科学]