逆行足背内侧皮神经营养血管皮瓣急诊修复前足缺损

Defects of fore foot repaired by reverse medial dorsal neurocutaneous flap of foot in emergency

目的探讨逆行足背内侧皮神经营养血管皮瓣急诊修复前足缺损的可行性。方法沿足背内侧皮神经走行设计皮瓣，内侧支以踝间线中点稍外侧至第1跖趾关节内侧缘连线为轴线，外侧支以踝间线中间至第2趾蹼中点连线为轴线，蒂位于足远端，根据创面大小由深筋膜层切取，皮瓣中的足背内侧皮神经近断端与创面附近足底趾固有神经吻合，急诊修复11例。结果皮瓣全部成活，8例随访6～11个月，前足皮肤耐磨无破溃，足行走负重功能较好，痛触觉恢复，两点辨别觉为2～3cm。结论逆行足背内侧皮神经营养血管皮瓣修复前足缺损，手术简单，不损伤知名血管，供区损伤小，感觉恢复满意，是急诊修复足前端组织缺损的较好方法。

Objective To investigate the possibility of repairing the defects of fore foot by reverse medial dorsal neuroeutaneous flap on foot in emergency. Methods Flap was designed along medial dorsal cutaneous nerve of foot, the axis of the medial branch was the line between lateral part of malleolar middle point and medial part of first metatarsophalangeal joint, and the axis of the lateral branch was the line between middle point of two malleolars and the tip of the great toe webspace, the pediele located on the distant part of the foot. Based on the size of wound, the flap was cut off from the deep fascia layer, and medial dorsal cutaneous nerve of foot was anastomosed with nerve of digitales plantares proprii. All patients were operated in emergency. Results Eleven patients with defect of fore foot were perfeetively recovered and all the wounds healed primarily. The appearances and functions of the loots were satisfactory, with two point sensation of 2-3 em after 6-11 months postoperatively and without any skin fester. Conclusion Medial dorsal cutaneous nerve of foot has advantages as follows： simply procedures, avoidance of sacrificing major arteries, less harm to donor area, good recovery of sensation. So it is a good method to repair tissue defects of fore foot.