异体跟骨移植及腓肠神经营养血管皮瓣修复跟骨缺损

REPAIR OF CALCANEUS AND SKIN DEFECTS WITH ALLOGRAFT AND SURAL NEUROVASCULAR FLAP

目的 探讨应用同种异体跟骨移植及腓肠神经营养血管逆行岛状皮瓣 ,修复跟骨缺损的临床效果。 方法 1996年 2月～ 2 0 0 2年 12月 ,采用同种异体跟骨移植及吻合腓肠神经营养血管皮瓣修复足跟骨缺损 6例。致伤原因为车祸伤 3例 ,机器绞扎伤 2例 ,砸伤 1例。其中跟骨后 1/ 3缺损 3例 ,后 1/ 2缺损 2例 ,后 2 / 3缺损 1例 ,均伴有足跟软组织不同程度缺损和跟腱断裂。皮瓣范围 6 cm× 7cm～ 12 cm× 17cm。急诊手术 2例 ,择期手术 4例。采用异体骨修复跟骨缺损 ,跟腱“Z”字形延长钢丝固定于再造跟骨粗隆处 ,修复软组织缺损。 结果 4例皮瓣全部成活 ,2例皮瓣远端部分坏死 ,经换药后创面愈合。术后 X线片显示 :移植异体骨对位良好 ,恢复了足跟结构。术后 3～ 6个月足跟部皮瓣感觉恢复。所有患者均获随访 6个月～ 3年 ,植入的异体骨骨性愈合 ,未见明显吸收、感染和排斥反应等并发症。足外形饱满 ,可负重行走。 结论 应用同种异体跟骨修复跟骨缺损 ,取材方便 ,且符合人体自然结构及功能要求。采用腓肠神经营养血管皮瓣 ,不牺牲肢体的主要血管 ,手术风险小 ,操作简便、外形好、有感觉 。

Objective To investigate the clinical results of allograft and sural neurovascular flap in repairing calcaneus and skin defects.Methods From February 1996 to December 2002, allograft and sural neurovascular flap were used to repair calcaneus and skin defects in 6 cases. The causes included road accident in 3 cases, strangulation in 2 cases and crashing object in 1 case. The defect locations were at the back of the calcaneus( 1/3, 1/2 and 2/3 of calcaneus in 3 cases, 2 cases and 1 case respectively). The flap area ranged from 6 cm×7 cm to 12 cm×17 cm. Results (The flaps) survived completely in 4 cases; the distal flaps necrosed partly in 2 cases and the wound healed by dressing. The postoperative X-ray films showed that the repaired bone and joint had normal position and the arcus plantaris recovered. After a follow up of 6 months to 3 years all the patients were achieved bone union in allograft and had no complications of absorption, infection and repulsion. The weight-bearing and walking functions were restored and the injured foot obtained a satisfactory contour. After 3-6 months of operation, the sensory recovery of foot occurred. Conclusion The used allograft is easy to be obtained and arcus plantaris is easy to recover. The reverse sural neurovascular flap in repairing calcaneus and skin defects has the following advantages: the maintenance of blood supply for injured foot, the less dangerous operation, the simple procedure, the recovery of walking function, and the good appearance and sensation.