低旋转点腓肠神经营养血管远端蒂皮瓣修复踝足部软组织缺损

Lower rotating point nutrient vessels of sural nerve flap with distant pedicled repairing soft tissue defect of foot and ankle

目的探讨低旋转点腓肠神经营养血管远端蒂皮瓣修复踝足部软组织缺损。方法2003年2月至2004年8月在解剖学研究的基础上,采用低旋转点的腓肠神经营养血管远端蒂皮瓣11例,缺损性质:车祸伤7例,重物压伤1例,电锯伤1例,皮肤恶性肿瘤1例,足跟慢性溃疡1例。缺损部位:足跟部6例,小腿下段2例,跟腱部2例,中前足背1例。轴点在外踝尖上1～3cm处,平均为2cm,皮瓣切取的面积为6cm×8cm～12cm×18cm。结果所有皮瓣均成活。术后有2例远端部分皮肤坏死,但其皮下有肉芽生长,其中1例经换药愈合,1例用中厚皮植皮愈合。所有病例均经1.5个月至6个月以上随访,患肢正常步态行走,皮瓣耐磨,有痛觉。结论低旋转点的腓肠神经营养血管远端蒂皮瓣,供区存在状态良好,可利用性大,邻近转移,切取方便,成活率高,是踝足部及小腿下段皮肤软组织缺损修复的理想供区。

Objective To explore lower rotating potint nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle. Methods Lay a foundation of anatomic studying from february 2003 to March 2004, using lower rotating point nutrient vessels of sural nerve flap with distant pedicled repairing the soft tissue defect of foot and ankle in 11 cases. Cause of injuring: traffic accident 7 cases, crushing 1 case, saw injuring 1 case, skin cancer 1 case, chronic ulcer 1 case. Areas; foot heel 6 cases, shand lower section 2 cases, heel tendon 2 cases, the distant back of the foot 1 case. Using the flap axis point was 1cm-3cm above the pink of the external heel,average 2cm. The scope of the flap was 6.0cm×8.0cm-12.0cm×18.0cm. Results All sural nerve flap were lively. About all,2 cases have distant part necrosis, accompanying with subcutaneous tissue 1 case heels after change dressings, another heels after skin grating. All case can walk as usal, the flap has wear-resisting and keenly feel. Conclusion Lower rotating point nutrient vessels of sural nerve flap, donner area exiting fine, utlizing scope large, skin nice, grating easy, no hurting important blood vessle,alive rate high,it is an good donner area in repairing around heel, foot and shand lower section.