腓肠神经营养血管肌皮瓣、皮瓣修复小腿及足踝部软组织缺损

Repair of soft tissue defect of leg and foot by myocutaneous flap and skin flap with sural nerve nutrient vessel

目的:探讨小腿及足踝部软组织缺损或骨缺损、骨髓炎的有效治疗方法。方法:小腿及足踝部软组织缺损患者31例,男19例,女12例;年龄8~84岁,平均36.7岁。其中胫腓骨中下段开放性骨折内固定术后感染5例,跟腱外露8例,外踝溃烂1例,足跟外露伴跟骨骨髓炎6例,跖骨慢性骨髓炎1例,足背皮肤癌2例,足背皮肤软组织缺损8例。皮瓣切取面积5.0cm×2.0cm^18.0cm×8.0cm。12例采用逆行腓肠神经营养血管肌皮瓣、19例采用逆行腓肠神经营养血管皮瓣转移方法进行治疗。结果:31例中29例完全存活,2例皮瓣远端部分坏死,经换药瘢痕愈合。经2~51个月随访(平均27个月),皮瓣质地优良,外观满意,12例行腓肠神经营养血管肌皮瓣转移患者,感染控制,无一例复发。结论:腓肠神经营养血管肌皮瓣、皮瓣解剖简单、血供可靠,手术成功率高,是临床上修复小腿及足踝部软组织缺损的良好选择。

Objective： To evaluate the outcomes and indications of myocutaneous flap and island flaps with the pedicle of sural nerve and vessels in repairing skin and soft tissue defect in the leg and foot. Methods： Thirty-one patients with skin and soft tissue effects in the leg and foot were involved, there were 19 male and 12 female, aged from 8 to 84 years （average 36.7 years）. Twelve patients were treated with myocutaneous flap and island flaps of sural nerve nutrient vessel. Nineteen patients were treated with island flaps of sural nerve nutrient vessel. Results ： Of all the 31 patients, flaps of 29 patients survived at the first intention. Partial necrosis appeared in 2 flaps but was cured at the second intention. All cases were followed-up for 2 to 51 months （mean 27 months）, the appearance and function were satisfactory in all cases. Conclusion： To repair soft tissue defect of the leg and foot with osteomyelitis, the myocutaneous flap and skin flap of sural nerve nutrient vessel is a satisfactory method.