腓肠神经营养血管皮瓣修复足踝部软组织缺损的临床应用  

Application of sural neurouascular flap in repair of soft tissue defect of foot and ankle

作　　者：陈占斌 石荣剑 杨龙 曹广超 秦祥钧 CHEN Zhanbin;SHI Rongjian;YANG Long;CAO Guangchao;QIN Xiangjun(Department of Foot and Ankle Surgery,Xuzhou Renci Hospital,Xuzhou,Jiangsu Province 221000,China)

机构地区：[1]徐州仁慈医院足踝外科,江苏徐州221000

出　　处：《中华显微外科杂志》2022年第4期383-388,共6页Chinese Journal of Microsurgery

摘　　要：目的总结应用腓肠神经营养血管皮瓣逆行转移修复足踝部软组织缺损的经验, 探讨促进皮瓣成活、外形美观的方法。方法回顾性分析2019年10月至2020年6月在徐州仁慈医院足踝外科采用腓肠神经营养血管皮瓣修复足踝部软组织缺损的10例患者资料, 其中男8例, 女2例;年龄18~54岁, 平均42.5岁;致伤原因:车祸伤8例, 跟骨骨折术后切口坏死2例;软组织缺损面积4.0 cm×6.0 cm~16.0 cm×10.0 cm, 应用腓肠神经营养血管皮瓣进行修复, 并优化方法:①把瓣部内小隐静脉分离出来保留于肢体内, 优化静脉回流;②游离进入蒂部的腓动脉穿支血管, 入蒂处为旋转点, 蒂部内仅包含腓肠神经血管链、小隐静脉主干及筋膜组织, 宽度2.0 cm左右, 既增加皮瓣血供又美化蒂部;③蒂部扭转处设计成弧形皮瓣覆盖并采用明道转移, 预防卡压;④供区采用接力皮瓣覆盖, 根据供区位置选用腓动脉近端穿支皮瓣或腓肠内、外侧动脉穿支皮瓣;⑤部分病例腓肠神经与创周感觉神经缝接。术后随访观察皮瓣成活情况, 采用Maryland足功能评分及英国医学研究委员会(BMRC)感觉功能评定对皮瓣及肢体功能恢复情况进行评估。结果 10例患者均获得随访, 随访6~12个月, 平均8.5个月, 供、受区皮瓣完全成活, 小腿外形美观, 皮瓣质地柔软, 弹性好, 耐磨,3例缝接神经的皮瓣感觉按照BMRC进行评定, 达到S3级以上, 患者满意度高;末次随访时按照Maryland评分系统评定疗效, 结果85~98分, 平均91.6分, 获优8例, 良2例。结论腓肠神经营养血管皮瓣供血充足, 静脉回流合理, 皮瓣成活率高;供区接力皮瓣覆盖获得了良好的外形, 缝接了感觉神经使皮瓣具有感觉;修复后足踝部功能恢复良好, 疗效满意。Objective To summarise the experience in use of sural neurouascular flap in repair of the soft tissue defects of foot and ankle,and explore the methods in promoting the survival and appearance of the flap.Methods Data of 10 patients who underwent sural neurocutaneous flap surgery for repairing soft tissue defects in the foot and ankle in the Department of Foot and Ankle of Xuzhou Renci Hospital from October 2019 to June 2020 were retrospectively analysed.Among the 10 patients,8 were males and 2 were females,and the age ranged from 18 to 54 years old,with an average age of 42.5 years old;Causes of injury:8 patients injured by traffic accident and 2 by incision necrosis after calcaneal fracture operation.The areas of soft tissue defect were 4.0 cm×6.0 cm-16.0 cm×10.0 cm.Sural neurouascular flap was used for the defect repairs.Method of optimisation:①The small saphenous vein in the flap was separated and retained in the limb to optimise the venous circulation.②Freed peroneal perforator vessels that entered the pedicle,and made the point where the vessels entering the pedicle as the rotation point.The pedicle contained the sural neurovascular bundle,the main trunk of the small saphenous vein and the fascia tissue,with a width about 2.0 cm.It not only increased the blood supply of the flaps,but also a good appearance of the pedicle.③The torsion of the pedicle was covered by an arc-shaped flap and transferred through an open channel to prevent compression.④The donor site was covered with relay flap.According to the location of the donor site,a proximal peroneal artery perforator flap or medial and lateral sural artery perforator flap was selected.⑤Sural nerve was anastomosed with the peripheral sensory nerve in some cases.The survival of the flap,Maryland Foot Function Score and British Medical Research Council(BMRC)sensory function evaluation were investigated in the follow-up to evaluate the functional recovery of the flap and limb.Results All the 10 patients received the follow-up for 6 to 12 months,with

关 键 词：足踝软组织缺损 腓肠神经营养血管皮瓣 小隐静脉 腓肠外侧动脉 接力皮瓣 

分 类 号：R658.3[医药卫生—外科学]