腓肠神经营养血管皮瓣修复足底黑色素瘤切除术后创面的适用范围及手术技巧  

Application of sural neurovascular flap for repairing soft-tissue defect after resection of plantar melanoma

作　　者：王映华 董忠根[2] 陶世斌[2] 魏建伟 沈奕[2] 张志国[3] Wang Yinghua;Dong Zhonggen;Tao Shibin;Wei Jianwei;Shen Yi;Zhang Zhiguo(Xiangtan Medicine&Health Vocational College,Xiangtan 411104,Hunan,China;Department of Orthopedics,Second Xiangya Hospital,Central South University,Changsha 410011,Hunan,China;Department of Orthopedics,Hunan Provincial Rehabilitation Hospital,Changsha 410007,Hunan,China)

机构地区：[1]湘潭医卫职业技术学院,湖南湘潭411104 [2]中南大学湘雅二医院骨科,湖南长沙410011 [3]湖南省康复医院骨科,湖南长沙410007

出　　处：《中国现代手术学杂志》2023年第1期64-68,共5页Chinese Journal of Modern Operative Surgery

基　　金：国家自然科学基金面上项目(81672188);湘潭医卫职业技术学院2021年度校级科研课题(ZRKX2021-03)。

摘　　要：目的探讨腓肠神经营养血管皮瓣修复足底黑色素瘤广泛切除术后皮肤软组织缺损的适用范围及提高皮瓣成活率的手术技巧。方法回顾性分析行足底黑色素瘤广泛切除术的18例患者的临床资料。原发灶位于跟底区12例,外侧负重区3例,足弓区3例。Breslow厚度1.1~5.4 mm。均采用腓肠神经营养血管皮瓣重建足底皮肤软组织缺损。皮瓣大小(6.0 cm×7.0c m)~(14.0 cm×10 cm),其中14例皮瓣大于8.0 cm×8.0 cm。以旋转点至创面近端距离最短为依据选择皮瓣的转位方向和路径。结果18例患者随访2~53个月,平均8.9个月。术后17例皮瓣成活;1例修复跟底区创面皮瓣出现部分坏死,经植皮后残留创面愈合。随访期内患肢均能负重行走,无明显疼痛,局部无复发征象,皮瓣无溃疡。AOFAS评分:优7例,良10例,可1例。1例患者术后1年出现远处转移。结论腓肠神经营养血管皮瓣修复足底黑色素瘤广泛切除术后创面具有操作简便、血运可靠、成活面积大、修复范围较广、安全可行等优点,是重建足底部跟底区、足弓区及外侧负重区黑色素瘤广泛切除术后皮肤软组织缺损的一种较好的方法。Objective To investigate the application scope and surgical technique of sural neurovascular flap for repairing the soft-tissue defect after extensive excision of the plantar melanoma.Methods The clinical data of 18 patients with plantar melanoma performed extensive resection of primary lesion were analyzed retrospectively.The primary tumors were located in plantar heel area in 12 cases,lateral weight-bearing area in 3 cases and arch area in 3 cases,with the Breslow thickness ranged from 1.1 to 5.4 mm.The sural neurovascular flaps were used to reconstruct the plantar defects.The dimension of the skin islands ranged from 6.0 cm×7.0 cm to 14.0 cm×10.0 cm,of which 14 skin islands were larger than 8.0 cm×8.0 cm.The transferred direction and path of the flap were selected according to the shortest distance from the pivot point to the proximal edge of the defect.Results All patients were followed up for 2 to 53 months with an average of 8.9 months.The flap survived in 17 cases;partial necrosis occurred in one flap which reconstructed the defect of plantar heel area,and the residual wound was successfully resurfaced by skin grafting.During the follow-up period,the affected limbs recovered walking without obvious pain,local recurrence of the tumor and ulceration of the flap.The AOFAS scores were excellent in 7 cases,good in 10 cases and fair in 1 case.Distant metastases was found in 1 cases one year after the operation.Conclusion The sural neurovascular flap repair is a safe and feasibile method for reconstruction of the soft-tissue defect after extensive resection of the melanoma located in the plantar heel area,arch area and lateral weight-bearing area with advantages of simple procedure,reliable blood supply,large survival area and wide repair scope.

关 键 词：腓肠神经营养血管皮瓣 黑色素瘤 足底 

分 类 号：R739.5[医药卫生—肿瘤]