不同方法修复儿童足跟轮辐伤皮肤缺损伴跟腱外露  

Different methods for repairing heel skin defect with achilles tendon exposure suffered from spoke injuries in children

作　　者：董云飞 陶忠生[2] 吴清华[2] 杨红志 王延杰 冯亚高[2] DONG Yun-fei;TAO Zhong-sheng;WU Qing-hua;YANG Hong-zhi;WANG Yan-jie;FENG Ya-gao(Dept of Orthopaedics,the Seventh Hospital of Baoding City,Baoding,Hebei 072150,China;Dept of Hand-Foot Surgery,the 82nd Group Army Hospital of CPLA,Baoding,Hebei 071000,China)

机构地区：[1]保定第七医院骨科,河北保定072150 [2]中国人民解放军第八十二集团军医院手足外科,河北保定071000

出　　处：《临床骨科杂志》2021年第1期64-66,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨不同方法修复儿童足跟轮辐伤皮肤缺损伴跟腱外露的临床效果。方法采用腓肠神经营养血管皮瓣、足跟外侧动脉皮瓣和邻位局部内侧或外侧旋转皮瓣3种皮瓣以及人工真皮覆盖修复22例儿童足跟部轮辐伤皮肤缺损伴跟腱外露创面。观察创面愈合情况。结果患儿均获得随访,时间3~10个月。2例腓肠神经营养血管皮瓣远端皮缘发生血运障碍导致小部分皮缘缺血坏死,1例足跟外侧动脉皮瓣远端部分缺血坏死,2例人工真皮修复创面患儿出现轻度感染,以上患儿均经换药后创面逐渐愈合;其余患儿创面术后均顺利愈合。末次随访时,患足外形不臃肿,踝关节屈伸活动正常,穿鞋走路基本无影响。结论根据足跟缺损创面的大小和形状,采用不同方法修复儿童足跟轮辐伤皮肤缺损伴跟腱外露均能取得良好的临床效果,但应遵循皮瓣能近勿远,能带蒂就不采用吻合血管的修复原则,严格按照皮瓣切取要求,树立微创和美观理念。Objective To investigate the clinical efficacy of different methods for repairing heel skin defect with exposure of ahilles tendon suffered from spoke injuries in children.Methods The 22 children with heel skin defect with exposure of ahilles tendon who were suffered from spoke injuries were selected,they were treated with three kinds of flaps(sural neurovascular flap,heel lateral artery flap,local medial and lateral rotation flap)and artificial dermis covering.The wound healing situation was observed.Results All patients were followed up for 3~10 months.The 2 cases who had blood circulation disorder at the distal margin of sural neurovascular flap caused a small part of the skin margin ischemic necrosis,1 case had ischemic necrosis at the distal part of lateral heel artery flap,and the 2 children who were repaired by artificial dermis had mild infection of the wound surface.The wounds of the above children healed gradually after dressing change;the other children′s wounds healed smoothly.At the last follow-up,the affected feet was without bloated appearance,they had normal flexion-extension activities of ankle joint,there was no effect on their walking with shoes.Conclusions According to the size and shape of skin defect in the heel,good clinical effects can be achieved by using different methods to repair heel skin defect with exposure of ahilles tendon suffered from spoke injuries in children.However,the principle that the skin flap can not be far away,carry the pedicle does not anastomose vascular repair should be followed,and the principle of minimally invasive and aesthetic concepts should be established in strict accordance with the requirements of the incision of the flap.

关 键 词：足跟轮辐伤 皮肤缺损 跟腱外露 外科皮瓣 儿童 

分 类 号：R658.3[医药卫生—外科学] R622.1[医药卫生—整形外科]