阻断小隐静脉的腓肠神经营养血管逆行岛状皮瓣修复小腿及足踝部皮肤缺损  

Repair of skin defects at the leg,ankle and foot using retrograde sural neurovascular island flaps with blockade of small saphenous vein

作　　者：李远辉[1] 曾勉东[1] 王建炜[2] 尹德龙[1] 胡汉生[1] 余升华[1] 王钊[1] 吴宝杰[1] Li Yuanhui;Zeng Miandong;Wang Jianwei;Yin Delong;Hu Hansheng;Yu Shenghua;Wang Zhao;Wu Baojie(Second Department of Orthopedics,Third Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510150,China)

机构地区：[1]广州医科大学附属第三医院骨二科,510150 [2]广州市第一人民医院创伤骨科

出　　处：《中华生物医学工程杂志》2018年第4期278-282,共5页Chinese Journal of Biomedical Engineering

基　　金：广州医学院科学研究项目(2013A18)。

摘　　要：目的探讨采用阻断小隐静脉的腓肠神经营养逆行岛状皮瓣修复小腿及足踝部皮肤缺损的临床疗效。方法回顾性分析2012年1月至2016年12月,39例因外伤、感染导致的小腿、踝关节、足部皮肤软组织缺损患者(创面面积3.5 cm×3 cm~9.0 cm×7.2 cm),根据手术方式分为对照组19例,结扎组20例,均采用腓肠神经营养血管逆行岛状皮瓣修复创面。其中对照组皮瓣面积4 cm×3.5 cm~10 cm×6.5 cm,在皮瓣近端结扎并离断小隐静脉;结扎组皮瓣面积5 cm×3 cm~10 cm×8 cm,在对照组基础上于外踝后方分离结扎小隐静脉起始处。术后比较两组皮瓣肿胀发生率、青紫发生率、皮瓣完全成活率。末次随访观察成活皮瓣质地、皮瓣供区愈合、踝关节功能情况。结果所有患者均获随访,平均(33.5±8.6)月。5例皮瓣坏死,34例皮瓣完全成活。结扎组皮瓣肿胀发生率低于对照组(10%比47.37%,P<0.05),皮瓣完全成活率明显高于对照组(100%比73.68%,P<0.05);两组在皮瓣青紫发生率无统计学意义(P>0.05)。末次随访两组所有成活皮瓣质地、踝关节功能、皮瓣供区创面愈合及功能良好。结论阻断小隐静脉的腓肠神经营养逆行岛状皮瓣是修复小腿及足踝部皮肤缺损的一种较好的方法。Objective To investigate the clinical effect of retrograde sural neurovascular island flaps with blockade of small saphenous vein in the repair of skin defects at the leg,ankle and foot.Methods The clinical data of 39 patients with skin and soft tissue defects(defect area 3.5 cm×3 cm⁃9.0 cm×7.2 cm)at the leg,ankle and foot caused by trauma or infection,who stayed in our hospital between January 2012 and December 2016,were retrospectively analyzed.According to the operation methods,the patients were divided into the control group(n=19)and ligation group(n=20).The defects were repaired with retrograde sural neurovascular island flaps.The area of skin flaps in the control group and study group was 4 cm×3.5 cm⁃10 cm×6.5 cm and 5 cm×3 cm⁃10 cm×8 cm,respectively.The small saphenous vein was ligated and blocked at the proximal site of the flaps in the control group.In addition,the initiation of the small saphenous vein was dissected at behind the lateral malleolus and then further ligated in the ligation group.The incidences of swelling,cyanosis,and complete survival rate of the flaps were compared between the two groups.The flap texture,donor site healing,and ankle joint function at the last follow⁃up were evaluated.Results Flap necrosis was found in 5 cases.Thirty⁃four flaps survived completely and were followed up for 8⁃60 months with an average of(33.5±8.6)months.The incidence of flap swelling in the ligation group was lower than that in the control group(10%vs 47.37,P<0.05).The complete survival rate of flaps in the ligation group was significantly higher than that in the control group(100%vs 73.68%,P<0.05).There were no statistical significance in the flap cyanosis between the two groups(P>0.05).The texture of all surviving flaps,ankle joint function,and donor site healing and function in the two groups were good at the last follow⁃up.Conclusion Blocking small saphenous veins of retrograde sural neurovascular island flaps favors the repair of skin defects at the leg,ankle and foot.

关 键 词：皮瓣 腓肠神经 小隐静脉 足踝部 小腿 

分 类 号：R658.3[医药卫生—外科学]