高原地区穿支蒂皮神经营养血管皮瓣在下肢软组织缺损修复中的应用  

Application of perforator-based neurocutaneous flap in repair of soft tissue defects of lower extremity in plateau area

作　　者：秦桂兰[1] 尼玛德吉[1] 马小刚[1] 王元胜[1] 柴益民[2] QIN Guilan;NIMA Deji;MA Xiaogang;WANG Yuansheng;CHAI Yiming(Department of Orthopaedics,Tibet Autonomous Region People's Hospital,Lhasa 850000,China)

机构地区：[1]西藏自治区人民医院骨科,拉萨850000 [2]上海市第六人民医院骨科,上海200233

出　　处：《中华显微外科杂志》2021年第6期633-636,共4页Chinese Journal of Microsurgery

摘　　要：目的探讨在高原地区应用穿支蒂皮神经营养血管皮瓣修复下肢软组织缺损的临床疗效。方法2017年8月至2019年12月,采用穿支蒂皮神经营养血管皮瓣局部转移修复下软组织缺损48例,其中男29例,女19例,年龄17~65岁。穿支蒂腓肠神经营养血管皮瓣23例,穿支蒂隐神经营养血管皮瓣15例,穿支蒂腓浅神经营养血管皮瓣10例。软组织缺损面积4.0 cm×3.5 cm~15.0 cm×12.0 cm,皮瓣面积6.0 cm×4.5 cm~16.0 cm×13.0 cm。供区创面直接缝合17例,植皮修复31例。术后定期随访。结果本组48例皮瓣完全成活33例;9例术后出现皮瓣边缘坏死,通过高压氧舱及换药后成活;6例完全坏死,通过负压吸引及植皮治疗得到二期愈合。随访6~12个月,平均9.6个月,皮瓣外形质地良好,患者关节活动、站立、行走等功能评价满意率达75.45%。结论穿支蒂皮神经营养血管皮瓣血运可靠,供区损伤小,是高原地区修复下肢软组织缺损的一种较好选择。Objective To investigate the clinical efficacy of perforator-based neurocutaneous flaps in repairing soft tissue defects of lower extremity in plateau area.Methods Forty-eight patients who received perforator-based neurocutaneous local flaps to repair soft tissue defects of lower extremity from August,2017 to December,2019 were entered a follow-up study.The patients were 17 to 65 years old,29 males and 19 females.There were 23 flaps with sural neurocutaneous perforator,15 with saphenous neurocutaneous perforators,and 10 with superficial peroneal neurocutaneous perforators.The size of soft tissue defects ranged from 4.0 cm×3.5 cm to 15.0 cm×12.0 cm.And the size of the flaps ranged from 6.0 cm×4.5 cm to 16.0 cm×13.0 cm.The donor sites of 17 cases were directly sutured,and the rest of 31 were repaired by skin graft.The regular follow-up was performed.Results Of the 48 cases,33 neurocutaneous flaps survived completely,9 had necrosis around edge of the skin after surgery and healed after hyperbaric oxygen therapy and dressing change,and 6 had complete necrosis after surgery and healed after vacuum assisted drainage and skin grafting.In 6 to 12(average,9.6)months of follow-up after surgery,the shape and texture of flaps were in good condition with the patient satisfaction rate on functional evaluation(joint motions,standing,walking)at 75.45%.Conclusion Perforator-based neurocutaneous flap is an excellent choice for the repair of soft tissue defects of lower extremity in plateau area because of its reliable blood supply and minimal damage to donor site.

关 键 词：穿支蒂皮神经营养血管皮瓣 下肢 修复 高压氧 高原地区 

分 类 号：R658.3[医药卫生—外科学]