踝周及后足部皮肤软组织缺损的不同类型皮瓣修复研究  

Skin flap repair of skin and soft tissue defects around the ankle and hind foot

作　　者：丰波[1] 代光明 王永军[1] 牛克成[1] 呼格 林立功[1] Feng Bo;Dai Guangming;Wang Yongjun;Niu Kecheng;Hu Ge;Lin Ligong(Department of foot and ankle surgery,the Third Clinical Medical College of Inner Mongolia Medical University,Baotou 014010,China)

机构地区：[1]内蒙古医科大学第三附属医院足踝外科,内蒙古包头014010

出　　处：《足踝外科电子杂志》2021年第3期17-24,共8页Electronic Journal of Foot and Ankle Surgery

基　　金：内蒙古医科大学第三附属医院项目(2011-11)。

摘　　要：目的总结应用不同类型皮瓣修复踝周及后足部皮肤软组织缺损的临床效果,并探讨皮瓣修复重建的重要性。方法回顾性分析2009年3月至2019年12月内蒙古医科大学第三附属医院应用不同类型皮瓣修复的踝周及后足部皮肤软组织缺损患者86例,应用皮瓣类型:带蒂皮瓣72例(包括内踝上穿支皮瓣11例、腓动脉外踝上穿支皮瓣8例、腓肠神经营养血管皮瓣37例、足底内侧皮瓣16例),游离股前外侧穿支皮瓣14例,皮瓣面积为(3.0 cm×3.5 cm)~(12.0 cm×20.5 cm);供区直接缝合36例,植皮覆盖50例。结果术后78例皮瓣成活,8例带蒂皮瓣部分坏死,其中4例供区植皮部分坏死,二期植皮或换药愈合。9例二期皮瓣修形,其中带蒂皮瓣4例,游离皮瓣5例,修复后皮瓣色泽、质地及外形良好。随访时间为2~23个月,平均14.5个月,其中5例随访时间短,无感觉恢复,其余皮瓣两点辨别觉(two-point discrimination,2PD)为6~15 mm。术后,Boyden足踝功能评估优74例、良12例,美国足踝外科协会(the American Orthopaedic Foot andAnkle Society,AOFAS)踝-后足功能评分为(86.31±3.42)分,踝关节及后足功能恢复满意。结论踝周及后足部组织结构特殊、功能重要,软组织缺损易引起足部功能障碍,根据缺损部位、大小、功能及美观需求,个性化选择不同类型的皮瓣修复,可取得良好效果。Objective To summarize the clinical effects of using different types of flaps to repair skin and soft tissue defects around the ankle and hind foot,the importance of flap repair and reconstruction was discussed.Methods A retrospective analysis of 86 cases of repairing skin and soft tissue defects around the ankle and hind foot with different types of skin flaps in the Third Clinical Medical College of Inner Mongolia Medical University,from March 2009 to December 2019.Types of flaps used:72 cases of pedicled skin flaps,including 11 cases of medial malleolus perforator skin flaps,8 cases of lateral malleolus perforator skin flaps,37 cases of sural nerve nutrient vessel skin flaps and 16 cases inner plantar skin flaps;14 free anterolateral thigh perforator flaps,with flap area ranging from (3.0 cm×3.5 cm) to (12.0 cm×20.5 cm).36 cases were sutured directly at the donor site,and 50 cases were covered with skin grafts.Results All 78 skin flaps survived the operation,8 cases had partial necrosis of pedicled skin flaps,4 cases of them had partial necrosis of skin grafts at the donor site,and the secondary skin grafts healed with dressing change.9 cases of secondary flaps were repaired,including 4 cases of pedicled flaps and 5 cases of free flaps.The color,texture and appearance of the flaps were good.Follow-up time ranged from 2 to 23 months,with an average of 14.5 months.The follow-up time of 5 cases was short and there was no recovery of sensation,and the two-point discrimination(2PD) of the remaining flaps was 6~15 mm.Boyden ankle function evaluation was excellent in 74 cases and good in 12 cases,the American Orthopaedic Foot and Ankle Society (AOFAS) score was (86.31±3.42) points,and the ankle and hind foot function recovered satisfactorily.Conclusion The tissue around the ankle and hind foot has a special structure and important functions.Soft tissue defects can easily cause dysfunction.According to different defect areas,sizes,functions and aesthetic requirements,different types of skin flaps can be individuall

关 键 词：组织缺损 皮瓣 踝 后足 

分 类 号：R274.32[医药卫生—中医骨伤科学]