皮神经营养血管皮瓣修复小腿下段及足踝部缺损

Repair of tissue defeats of lower limb and foot-ankle by neurovascular nutritional flap

目的探讨皮神经营养血管皮瓣在小腿下段及足踝部组织缺损修复中的应用效果。方法应用腓肠神经营养血管逆行皮瓣9例(其中不吻合小隐静脉者3例,吻合小隐静脉6例),隐神经营养血管逆行皮瓣3例(均吻合浅静脉),足背皮神经营养血管顺行或逆行皮瓣3例(其中足背内侧皮神经2例,足背外侧皮神经1例)。皮瓣面积最大16cm×10cm熏最小5cm×4cm。血管蒂长4～10cm,蒂宽3～4cm。结果临床应用15例,12例全部成活。2例未吻合小隐静脉的腓肠神经营养血管逆行皮瓣因静脉回流障碍远端部分坏死,二期植皮而愈;1例隐神经营养血管逆行皮瓣移位修复胫骨下端骨髓炎,感染灶导致皮瓣局部坏死,感染控制后局部皮瓣转移而愈;1例足跟部溃疡。结论腓肠神经、隐神经及足背皮神经营养血管皮瓣是修复小腿下段及足踝部组织缺损的理想皮瓣,可顺行或逆行移位,常规吻合浅静脉、缝合皮神经,有助于皮瓣成活及感觉功能恢复。

To discuss the clinical effect of cutaneous neurovascular nutritional flap in repairing tissue defeats of lower limb and foot-ankle. Methods Nine cases were repaired by reversed sural nerve nutritional flap （ anastomosed small saphenous in 6 cases and nonanastomosis in 3 cases）, 3 cases by reversed saphenous neurovascular flap （all were anastomosed superfical vein）and 3 cases by normal or reverse foot-dorsum neurocutaneous flap （2 cases with medial of foot-dorsum neurocutaneous and 1 case with lateral of foot-dorsum neurocutaneous）. The pedicle length of the flaps was 4-10cm, which include the largest flap was 16cm×l0cm and the smallest one was 5cm× 4cm.Results All the flaps survived completely. Small necrosis occurred in distal part of 2 without veno-anastomosis and cured by skin-grafting and in 1 case of reverse saphenous neurovascular flap repairing lower tibia osteomyelitis resulting from infection and cure by transfer flap.Heel ulcer occurred in 1 case result from friction.Concluslon Sural neurovascular nutritional flap,saphenous neurovascular flap and foot-dorsum neurocutaneous tissue defects of lower limb and foot-ankle which could been harvested and transfered proximally and distally. It is benefitial of flap survival rate and recovering sense by anastomosing the superficial vein and nutritional nerve.