足踝深部创面的修复

REPAIR OF DEEP WOUNDS OF THE FOOT AND ANKLE

目的总结足踝深部创面修复方法及临床效果。方法2002年3月～2006年6月,收治49例足踝部皮肤及深部组织缺损。其中男36例,女13例;年龄16～67岁,平均39岁。损伤原因:碾压伤24例,高处坠落伤9例,切割伤7例,恶性软组织肿瘤5例,褥疮2例,电击伤2例;左侧19例,右侧30例。皮肤缺损范围3cm×2cm～20cm×15cm。24例合并肌腱韧带缺损,12例合并关节外露,9例合并骨质缺失,35例合并不同程度感染,5例合并2期糖尿病。伤后至手术时间为4h～1年。创面修复分别采用:局部皮瓣15例,范围3cm×3cm～6cm×4cm;岛状皮瓣25例,范围8cm×5cm～12cm×7cm;游离皮瓣4例,范围15cm×11cm～24cm×17cm;交腿皮瓣5例,范围5cm×4cm～8cm×6cm。24例肌腱韧带缺损患者,15例行一期肌腱修复重建,余9例行二期肌腱移植重建术。9例合并骨质缺失患者于创面愈合后行二期植骨,植骨量12～64g,平均28g。结果49例移位皮瓣均成活,其中46例创面期愈合;3例皮瓣远端边缘部分坏死,经扩创植皮后创面愈合。2例术前有严重深部感染患者术后残留窦道,经6～8个月换药后窦道痊愈。患者获随访6个月～3年,移位皮瓣成活良好,无溃疡形成,足踝功能恢复良好。结论早期积极选择适当皮瓣进行足踝部创面修复,能恢复其良好外观和功能。

Objective To summarize the clinical effects of the repairing methods for deep wounds of the foot and ankle. Methods From March 2002 to June 2006, 49 patients with skin and deep tissue defects of the foot and ankle underwent the repairing treatment. Of them, 36 were males and 13 were females, aged 16 to 67 years（ 39 years on average）. The causes of injuries included mangled injury in 24 cases, high fall injury in 9 cases, cut injury in 7 cases, malignant soft tissue tumor in 5 cases, decubitat ulcer in 2 cases, and electric burn in 2 cases. Of the 49 cases, 19 were in left side and 30 in right side. The defect size of skin ranged from 3 cm × 2 cm to 20 cm × 15 cm and deep tissue injuries were accompanied by defects of tendon and ligament in 24 cases, by damage of joint in 12 cases, and by bone defect in 9 cases, and 35 of them had infections, and 2 of them had diabetes of stage 2. The time between the injury and surgery ranged from 4 hours to 1 year. The wounds were repaired separately by local flap （3 cm × 3 cm to 6 cm ×4 cm） in 15 cases, local island flap （8 cm × 5 cm to 12 cm ×7 cm） in 25 cases, free flap （15 cm× 11 cm to 24 cm × 17 cm） in 4 cases, and cross leg flap（5 cm×4 cm to 8 cm×6 cm） in 5 cases. In 24 cases of defects of tendon and ligament, 15 underwent the reconstruction in one-stage operations, 9 in two-satge operation. In 9 cases accompanied by bone defect, two-stage bone grafting （12-64 g） was given after wound healed. Results All of the 49 flaps survived. Forty-six healed by the first intention and 3 with distal edge necrosis healed after skin grafting. Two patients with sinus formation healed after 6-8 months of dressing change. All the cases were followed up 6 months to 3 years, and all the flaps were well developed, the functions of the foot and ankle were satisfactory. Conclusion It can get an excellent result of appearance and function recovery repairing deep wounds of the foot and ankle with proper flaps in earlier time.