应用改良腓肠神经营养血管皮瓣修复儿童足跟部轮辐伤  

Modified sural neurovascular flap to repair radial injuries of the heel in children

作　　者：韩健 龙翔云 吕白 谢小军 黄家菊 王洪凯 陈圆 秦燕峰 唐子茹 唐碧芸 Han Jian;Long Xiangyun;Lyu Bai;Xie Xiaojun;Huang Jiaju;Wang Hongkai;Chen Yuan;Qin Yanfeng;Tang Ziru;Tang Biyun(Department of Orthopaedics,the Second Affiliated Hospital of Guilin Medical College,Guilin,Guangxi 541199,China;Department of Blood Transfusion,the Second Affiliated Hospital of Guilin Medical College,Guilin,Guangxi 541199,China)

机构地区：[1]桂林医学院第二附属医院骨科,广西桂林541199 [2]桂林医学院第二附属医院输血科,广西桂林541199

出　　处：《创伤外科杂志》2023年第1期28-32,共5页Journal of Traumatic Surgery

基　　金：广西医疗卫生重点培育学科建设项目;广西医疗卫生适宜技术开发与推广应用项目(S2022145);桂林市科学研究与技术开发计划项目(20190218-6-4)。

摘　　要：目的探讨应用不携带腓肠神经及小隐静脉的改良腓肠神经营养血管皮瓣修复儿童足跟部轮辐伤的临床疗效。方法回顾性分析2018年10月—2020年8月桂林医学院第二附属医院骨科收治的12例儿童足跟部轮辐伤患者,其中男性9例,女性3例;年龄5~12岁,平均7.5岁;左侧7例,右侧5例;缺损面积范围2.5cm×3.5cm~4.0cm×8.0cm。均采用不携带腓肠神经及小隐静脉的改良腓肠神经营养血管皮瓣进行修复,皮瓣切取面积范围3.0cm×4.0cm~4.5cm×8.5cm,皮瓣供区宽度<4cm可直接缝合,部分宽于4cm供区,张力大,不能直接缝合,采用皮瓣多余皮肤或供区近端“猫耳”皮肤修剪成全厚皮片植皮修复。皮瓣存活后出院,定期门诊复查,观察皮瓣质地、肿胀程度及步态情况。结果12例患者均获得12~24个月随访,平均18.0个月。皮瓣均存活,其中一期存活11例,存活率91.7%;1例患者部分皮缘坏死,经换药后愈合。所有患者皮瓣不臃肿,无“猫耳”形成,质地与足跟部周围皮肤接近,无溃疡及胼胝形成,步态基本正常,美国足踝外科协会评分91~100分,平均95.0分。结论应用不携带腓肠神经及小隐静脉的改良腓肠神经营养血管皮瓣修复儿童足跟部轮辐伤血运可靠,不损伤主要血管,安全有效,值得临床推广。Objective To investigate the clinical effect of modified sural neurovascular flap without sural nerve and small saphenous vein in repairing wheel spoke injuries around the heel in children.Methods From Oct.2018 to Aug.2020,12 children with spoke injuries of the heel were retrospectively analyzed,including 9 male and 3 female aged 5-12 years,mean 7.5 years;7 left and 5 right.The defect size ranged from 2.5cm×3.5cm to 4.0cm×8.0cm.All the injuries were repaired with modified sural neurovascular flaps without sural nerve and small saphenous vein,and the flap harvesting area ranged from 3.0cm×4.0cm to 4.5cm×8.5cm.Most of the flap donor sites could be sutured directly(<4cm),and those with high tension was repaired by trimming the excess skin of the flap or the skin of the proximal“cat ear”of the donor site into a full-thickness skin graft.Patients were discharged after the flap survived.Regular outpatient follow-up was performed every month to exam the texture and swelling degree of the flap and gait.Results The 12 patients were followed up for 12-24 months,with an average of 18.0 months.All flaps survived,11 cases(91.7%)obtained primary survival,and the rest 1 had partial skin edge necrosis,which healed after dressing change.No bloating or“cat ear”was observed.The texture was close to the surrounding skin,without ulcer or callus formation.Almost normal gait was obtained.The American Orthopaedic Foot and Ankle Society(AOFAS)score was 91-100 points,mean 95.0 points.Conclusion The modified sural neurovascular flap without sural nerve and small saphenous vein is safe and effective in repairing wheel spoke injuries of the heel in children.

关 键 词：足跟部轮辐伤 改良腓肠神经 营养血管皮瓣 儿童 

分 类 号：R658[医药卫生—外科学]