改良隐神经营养血管复合组织瓣修复足部皮肤软组织缺损合并骨外露  

Modified saphenous nerve nutrivascular composite tissue flap for repairing skin and soft tissue defects with bone exposure on foot

作　　者：郑啸 张凯红 袁光华 邓焰峰 邓创伟 陈康 柳昊 ZHENG Xiao;ZHANG Kaihong;YUAN Guanghua;DENG Yanfeng;DENG Chuangwei;CHEN Kang;LIU Hao(Department of Orthopedics,Wuhan Xinzhou District People's Hospital,Wuhan 430400,Hubei,China;Department of Orthopedics,Wuhan Wuchang Hospital,Wuhan 430000,Hubei,China)

机构地区：[1]武汉市新洲区人民医院骨科,湖北武汉430400 [2]武汉市武昌医院骨科,湖北武汉430000

出　　处：《中国现代手术学杂志》2023年第6期475-480,共6页Chinese Journal of Modern Operative Surgery

基　　金：湖北省卫生健康委联合基金项目(WJ2019H348);武汉市卫生健康科研基金资助项目(WX19Q01);武汉市卫生健康科研基金资助项目(WX19D21)。

摘　　要：目的探讨改良隐神经营养血管复合组织瓣修复足部皮肤软组织缺损合并骨外露的疗效。方法回顾性分析2020年10月至2022年10月我院行改良隐神经营养血管复合组织瓣修复的52例足部皮肤软组织缺损并骨外露患者的临床资料,其中左足21例,右足31例;缺损面积(5.2 cm×2.1 cm)~(9.5 cm×3.6 cm)。采用美国矫形外科足踝协会(AOFAS)评分、Maryland足功能评分评价疗效与足部功能,采用英国医学研究会(BMRC)标准评估感觉功能恢复情况。结果本组52例患者手术均顺利完成,切取皮瓣面积为(6.1 cm×3.1 cm)~(10.3 cm×3.9 cm),手术时间(168.52±21.77)min,出血量(405.66±51.45)mL,住院时间(15.62±3.04)d,伤口愈合时间(28.54±3.64)d。皮瓣完全成活50例(96.15%),部分坏死2例(3.85%)。随访3~13个月,均无皮肤磨损、破溃等发生。术后发生动、静脉血管危象各1例。AOFAS评分为57~92分,平均(74.56±8.41)分,其中优20例,良30例,可1例,差1例,优良率为96.15%。Maryland足功能评分为47~98分,平均(72.56±3.16)分。BMRC感觉功能恢复:S3级1例(1.92%),S3+级5例(9.62%),S4级46例(88.46%)。2例出现轻微色素沉着,50例患者对皮瓣修复后外形、质地满意,行走功能及负重活动恢复良好。结论改良隐神经营养血管复合组织瓣修复足部皮肤软组织缺损并骨外露,皮瓣修复成功率高,足功能及感觉功能恢复良好,外形、质地满意,并发症发生率低,值得临床应用。Objective To explore the clinical effect of modified saphenous nerve nutrivascular complex tissue flap for repairing the skin and soft tissue defect with bone exposure on foot.Methods The clinical data of 52 cases with foot skin defects and bone exposure admitted from October 2020 to October 2022 were analyzed retrospectively,including 21 of left foot and 31 of right foot.The defect area ranged from 5.2 cm×2.1 cm to 9.5 cm×3.6 cm,and was repaired by modified saphenous nerve nutrivascular complex flap.The clinical efficacy was evaluated by American Orthopaedic Foot and Ankle Society(AOFAS)score,foot function was by Maryland Foot function Scale,and sensory function recovery was by the sensory function evaluation standard of British Medical Research Council(BMRC).Results The surgical intervention was accomplished successfully in all 52 cases,with grafting flap area of 6.1 cm×3.1 cm to 10.3 cm×3.9 cm.The operation time was 168.52±21.77 minutes,bleeding loss was 405.66±51.45 mL,hospitalization time was 15.62±3.04 days,and healing time was 28.54±3.64 days.The flap survived completely in 50 cases(96.15%),and partial necrosis of flap was found in 2 cases(3.85%).There was no skin wear or ulcear during 3 to 13 months follow-up.Arterial crisis and venous crisis occurred in one case respectively.The AOFAS score was 57 to 92 points,with an average of 74.56±8.41,and revealed excellence in 20 cases,good in 30 cases,fair in 1 case and poor in 1 case,and the fineness rate was 96.15%.The Maryland foot function scores ranged from 47 to 98,with an average of 72.56±3.16.According to BMRC standard,the sensory function was improved at grade S3 in 1 case(1.92%),grade S3+in 5 cases(9.62%)and grade S4 in 46 cases(88.46%).Mild pigmentation was found in 2 cases(3.85%),and appearance and texture of flaps and function of walking and weight-bearing activities were achieved satisfactory in 50 cases.Conclusion Modified saphenous nerve nutrient vascular composite flap can improve the success rate of repair,promote the recovery of sensor

关 键 词：隐神经营养血管皮瓣 修复 皮肤软组织缺损 足损伤 骨外露 

分 类 号：R658.3[医药卫生—外科学]