带腓动脉穿支的腓肠神经营养皮瓣在糖尿病足创面修复中的应用  

Application of sural neurotrophic flap with perforating branch of peroneal artery in the repair of diabetic foot wounds

作　　者：高磊 石宇 李天博 王江宁 GAO Lei;SHI Yu;LI Tianbo;WANG Jiangning(Department of Orthopedics,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院矫形外科,北京100038 [2]兵器工业卫生研究所,陕西西安710065

出　　处：《中国美容整形外科杂志》2022年第3期139-142,共4页Chinese Journal of Aesthetic and Plastic Surgery

基　　金：首都临床特色应用研究与成果推广(Z171100001017070)。

摘　　要：目的探讨带腓动脉穿支的腓肠神经营养皮瓣在糖尿病足创面修复中的临床应用效果。方法回顾性分析自2017年10月至2019年6月,首都医科大学附属北京世纪坛医院矫形外科收治50例糖尿病足患者的临床资料,根据治疗方法分为两组,观察组采用带腓动脉穿支的腓肠神经营养皮瓣治疗(25例),对照组同期采用封闭式负压引流联合植皮修复(25例)。比较两组术后创面感染例数、愈合时间及复发率。结果观察组术后1例发生血管危象,抢救失败皮瓣坏死,经再次手术清创及换药治疗创面愈合;对照组术后4例出现植皮修复区域移植皮肤坏死,再次手术清创及换药治疗创面愈合,其余患者术后无血管危象发生,无皮瓣静脉回流障碍形成的青紫。最终两组患者创面均愈合,其中观察组愈合时间为(15.72±2.62)d,对照组为(22.08±3.21)d,两组比较差异有统计学意义(t=-7.67,P<0.05)。随访6~12个月,期间因糖尿病足溃疡复发再次入院治疗的患者,观察组3例(12%),对照组8例(32%),观察组创面复发率低于对照组,差异有统计学意义(P<0.05)。结论与采用封闭式负压引流联合植皮修复相比,带腓动脉穿支的腓肠神经营养皮瓣修复创面可缩短创面愈合时间,其修复的创面复发率较低。Objective To explore the clinical application of sural neurotrophic flap with perforating branch of peroneal artery in the repair of diabetic foot wounds.Methods The clinical data of 25 patients with diabetic foot underwent sural neurotrophic flap with perforating branch of peroneal artery(observation group)from October 2017 to June 2019 were retrospectively analyzed.Compared with25 patients with diabetic foot repaired by vacuum sealing drainage combined with skin grafting in the same period(control group),the number of postoperative wound infection,wound healing time and recurrence rate during 1-year follow-up period were compared between2 groups.Results In the observation group,vascular crisis occurred in 1 patient and flap necrosis occurred after failed rescue.The wounds healed after surgical debridement and dressing change again.In the control group,the skin graft necrosis occurred in 4 patients,and the wounds healed after surgical debridement and dressing change again.No vascular crisis and cyanoderma caused by venous return disturbance of flap were found in the remaining patients.Finally,all wounds healed in both groups.The healing time in the observation group was(15.72±2.62)d,which was significantly shorter than that in the control group of(22.08±3.21)d,the difference was statistically significant between 2 groups(t=-7.67,P<0.05).All patients were followed up for 6 to 12 months.During the follow-up period,3 patients(12%)in the observation group and 8 patients(32%)in the control group were re-admitted to hospital because of diabetic foot ulcer recurrence.The recurrence rate of wounds in the observation group was significantly lower than that in the control group,the difference was statistically significant(P<0.05).Conclusion Compared with vacuum sealing drainage combined with skin grafting,the sural neurotrophic flap with perforating branch of peroneal artery in the repair of wounds could shorten the healing time and reduce the recurrence rate.

关 键 词：糖尿病足 腓动脉穿支 腓肠神经 皮瓣 封闭式负压引流 修复 

分 类 号：R587.2[医药卫生—内分泌]