大面积腓肠神经营养血管皮瓣的临床应用

Clinical application of the bigger sural neurocutaneous vascular flap

目的探讨大面积腓肠神经营养血管皮瓣的临床应用特点和临床效果。方法应用大面积的逆行腓肠神经营养血管皮瓣修复小腿下段及足踝部软组织损伤16例,皮瓣面积为26cm×12cm^18cm×9cm。手术设计以外踝上约5~7cm处为逆行皮瓣的蒂部旋转点,皮瓣上界可超过小腿中上1/3交界以上部位,但不宜超过腓骨头下5cm。术中注意:①增加皮瓣的筋膜蒂的宽度,不小于4~5cm;②腓肠神经内、外侧的皮神经都保留在皮瓣内;③在蒂部结扎小隐静脉,但把小隐静脉干包含在皮瓣内;④保证蒂部的宽松。结果16例中15例生长良好,1例皮瓣末端部分表皮坏死,经换药后愈合。术后随访2个月~3年,皮瓣质地良好,外观恢复满意。结论经采取一定措施后扩大面积的逆行腓肠神经营养血管皮瓣血供可靠,能满意地修复足跟、足底大部、足背、踝及小腿中下段胫前区软组织缺损。

Objective To explore the clinical practice characteristic and practice effect of sural neurocutaneous vascular flap. Methods Use extended sural neurocutaneous vascular flap repair shank section and foot ankle soft tissue damage 16, flap area 26cm × 12cm-18cm ×9cm. The surgery, designs take 5 cm-7cm place above the lateral malleolar approximately as the turning point of flap. The flap upper boundary may surpass on the leg center above 1/3, but not suitably surpasses under the capitulum fibulae 5cm. In attention ①increases the flap fascia peduncular width, the width was not smaller than 4-5cm; ② All cutaneous nerve retains in flap; ③ ligates the saphenous vein in the peduncle, but contains the saphenous vein in flap; ④ensures the peduncle looseness Results 15 grow well of the 16, some epidermises of an end of 1 flap were bad, heal after changing dressings. After a follow up to 2 months-3 years, the quality of the flaps were good, the appearance of the flaps were satisfactory. Conclusion Extended retrograde sural neurocutaneous vascular flap of blood supply are reliahle after taking certain measure, can ideal repair the defects of soft tissue in the heel, the greater part of sole, ankle and the district before the poor shank.