腓肠神经营养血管皮瓣及小腿近端自由设计穿支皮瓣连续转移修复足踝部软组织缺损  

Continuous transfer for repairing soft tissue defects of the foot and ankle by sural neurovascular flap and free-style perforator flap

作　　者：郭宗慧 唐寅 王骏杰 付有伟 杨长春 庞清江 Guo Zonghui;Tang Yin;Wang Junjie;Fu Youwei;Yang Changchun;Pang Qingjiang(Department of Orthopedics Center,Hand and Foot Surgery,HwaMei Hospital,University of Chinese Academy of Sciences,Ningbo 315010,China)

机构地区：[1]中国科学院大学宁波华美医院骨科中心、手足外科,315010

出　　处：《中华整形外科杂志》2021年第10期1152-1157,共6页Chinese Journal of Plastic Surgery

基　　金：宁波市医学重点扶植学科(2016-F06);浙江省医药卫生科技计划项目(2020KY840);中国科学院大学宁波华美医院华美基金项目(2021HMKY29)。

摘　　要：目的探讨腓肠神经营养血管皮瓣及小腿近端自由设计穿支皮瓣连续转移修复足踝部软组织缺损的临床效果。方法回顾性分析2011年2月至2020年2月中国科学院大学宁波华美医院收治的足踝部皮肤软组织缺损患者的临床资料。以腓肠神经营养血管皮瓣转移修复足踝部软组织缺损,并在小腿近端自由设计穿支皮瓣转移覆盖其供区。术后观察受区及供区早期皮瓣成活情况,并对后期形态、感觉、足踝部活动情况进行随访。结果共对11例足踝部软组织缺损患者采用这种皮瓣连续转移的方式进行修复。其中男7例,女4例,年龄(41±3)岁,创面面积3.0 cm×5.0 cm~7.0 cm×10.0 cm,腓肠神经营养血管皮瓣面积4.0 cm×10.0 cm~9.0 cm×17.0 cm,小腿近端穿支皮瓣面积4.5 cm×6.5 cm~5.5 cm×10.5 cm。术后所有皮瓣均一期成活,未发生感染、血管危象、皮瓣坏死等情况。患者均获随访,时间2~36个月,平均10.2个月,皮瓣形态和感觉恢复良好,未见瘢痕挛缩,足踝部皮瓣两点辨距觉为13~18 mm,踝关节背伸30°~45°、跖屈35°~45°,内、外翻角度均为30°~40°,未影响踝关节活动。结论腓肠神经营养血管皮瓣可以安全而有效地修复足踝部创面,小腿近端自由设计穿支皮瓣可以较好地修复供区,而且不牺牲主干血管。两种皮瓣连续转移修复足踝部软组织缺损的方法,既可获得良好的外观,同时又减少了功能损害。Objective To explore the clinical effect of continuous transfer of sural neurovascular flap and free-style perforator flap for repairing soft tissue defect of foot and ankle.Methods Clinical data of patients with skin and soft tissue defects of the foot and ankle from Ningbo HwaMei Hospital,University of Chinese Academy of Sciences were enrolled in this study from February 2011 to February 2020.The sural neurovascular flap was used to repair the soft tissue defect of the ankle and foot,and the free-style perforator flap was designed to cover the donor site in the proximal lower leg.The survival of the flaps in the recipient and donor sites were observed after surgery,and the morphology,sensation,and foot and ankle movement were followed up in the later period.Results A total of 11 patients with soft tissue defects in the ankle and foot were enrolled,including 7 males and 4 females,average aged 41±3 years old.The area of the wound defect was 3.0 cm×5.0 cm-7.0 cm×10.0 cm;the size of sural neurovascular flap was 4.0 cm×10.0 cm-9.0 cm×17.0 cm;and the size of perforator flap of the proximal lower leg was 4.5 cm×6.5 cm-5.5 cm×10.5 cm on average,respectively.All flaps were survived primarily without infection,vascular crisis,and flap necrosis.Patients were followed up for 2-36 months in this study,with an average of 10.2 months.There was no scar contracture being observed,and the shape and sensation of the flap of patients were recovered well.Two-point distance discrimination of the flap of ankle and foot was 13-18 mm.The angle of ankle dorsiflexion,plantar flexion,inversion,and eversion were 30°-45°,35°-45°,30°-40°,respectively.Conclusions We found that the wound of the foot and ankle could be safely and effectively repaired by the sural neurovascular flap,and the donor site on the proximal lower leg could be well repaired by free-style perforator flaps,with no sacrifice with the main blood vessel.Overall,these two methods can not only obtain a good appearance but also reduce functional damage.

关 键 词：穿支皮瓣 腓肠神经营养血管皮瓣 修复外科手术 足 踝 

分 类 号：R658.3[医药卫生—外科学]