低旋转点的隐神经营养血管远端蒂皮瓣修复前足背侧缺损创面

DISTALLY BASED SAPHENOUS NEUROCUTANEOUS FLAP OF LOWER ROTATING POINT REPAIRING SOFT TISSUE DEFECT IN DORSUM OF FOREFOOT

目的探讨低旋转点隐神经营养血管远端蒂皮瓣修复前足背侧缺损创面的术式,并总结其临床效果。方法 2005 年 1 月- 2007 年 8 月,应用低旋转点的隐神经营养血管远端蒂皮瓣修复前足背侧皮肤软组织缺损创面 6 例。男 4 例,女 2 例;年龄 28 ～ 53 岁。左足 2 例,右足 4 例。重物压砸伤 5 例,车祸伤 1 例。患足均伴肌腱、骨外露或坏死皮肤软组织切除后肌腱、骨外露。急诊手术 2 例,择期手术 4 例。清创后创面缺损为 7.0 cm × 5.0 cm ～ 9.0 cm × 5.5 cm。皮瓣旋转点位于内踝上 1 ～ 3 cm 处,切取皮瓣大小为 8.0 cm × 6.0 cm ～ 13.0 cm × 6.5 cm。其中 2 例将皮瓣内隐神经近断端和创面内足背内侧皮神经残端吻合。供区创面中厚皮片植皮修复。结果 4 例术后皮瓣顺利成活;2 例术后 2 d 皮瓣远端出现肿胀、水疱,经对症处理后愈合。供区植皮全部成活。6 例患者均获随访,随访时间 6 ～ 18 个月。皮瓣厚薄、颜色及质地接近受区。术中吻合神经的 2 例皮瓣痛、温觉恢复,两点辨别觉分别为 8 mm 和 9 mm;未吻合神经的4 例皮瓣恢复保护性感觉。患足负重行走正常,皮瓣无皮肤破溃。结论低旋转点的隐神经营养血管远端蒂皮瓣血供可靠,是修复前足背侧缺损创面的一种较好方法。

Objective To investigate the surgical methods and clinical resuks of reconstructing sort tissue detects in dorsum of forefoot with distally based saphenous neurocutaneous flap of lower rotating point. Methods From January 2005 to August 2007, 6 cases of soft tissue defects in dorsum of forefoot, including 4 males and 2 females aged 28-53 years, were treated with the distally based saphenous neurocutaneous flaps of lower rotating point. The soft tissue defect was in left foot in 2 cases and in right foot in 4 cases. Five cases of soft tissue defects were caused by crush, and 1 case was caused by traffic accident. Tendons and bones were exposed in all cases. The defects after debridement were 7.0 cm×5.0 cm to 9.0 cm×5.5 cm in size. Emergency operation was performed in 2 cases and selective operation in 4 cases. Rotating point of the flaps was from 1 to 3 cm above medial malleolus. The size of the flaps ranged from 8.0 cm× 6.0 cm to 13.0 cm× 6.5 cm. Neuroanastomosis was performed in 2 cases of the flaps. Skin defects in donor site were repaired with thickness skin graft. Results Four cases of the transferred flaps survived completely and the other 2 cases began to swell and emerge water blister from the distant end of the flap after operation, which resulted in distal superficial necrosis of flaps, healing was achieved after change dressings and skin grafted. Skin graft in donor site survived completely in all cases. All cases were followed up from 6 to 18 months. The color and texture and thickness of the flaps were similar to recipient site. Pain sensation and warmth sensation of the 2 flaps whose cutaneous nerve were anastomosed recovered completely, two point discrimination were 8 mm and 9 mm respectively. Sensation and warmth sensation of the 4 flaps whose cutaneous nerve were not anastomosed recovered partly. All patients returned to their normal walking and running activities and no ulceration occurred. No donor site morbidity was encountered. Condusion Blood supply of the distally based saphenous neurocutaneous flap of lower rotating point is sufficient, the flap is especially useful for repair of soft tissue defects in dorsum of forefoot.