腓动脉主穿支蒂腓肠神经营养血管皮瓣修复足踝部中小面积软组织缺损

REPAIR OF SMALL AND MEDIUM-SIZED SOFT TISSUE DEFECT IN ANKLE WITH SURAL NEUROCUTANEOUS VASCULAR FLAP PEDICLED ON MAIN PERFORATING BRANCH OF PERONEAL ARTERY

目的总结不依赖低位穿支的单一腓动脉主穿支蒂腓肠神经营养血管皮瓣修复足踝部中小软组织缺损的手术方法及临床效果。方法2004年7月-2007年2月,收治14例足踝部中小面积软组织缺损患者。男9例,女5例;年龄19～53岁。跟腱断裂术后皮肤坏死4例,交通伤后软组织缺损3例,重物压砸伤、慢性感染溃疡及跟骨骨折术后皮肤坏死各2例,黑色素瘤切除术后1例。软组织缺损范围4 cm×2 cm～9 cm×5 cm;位于踝周12例,跟底负重区2例。均合并深部肌腱或骨组织外露。急诊入院3例,其余患者于伤后12 d～13个月入院。术中切取以腓动脉主穿支为单一蒂的腓肠神经营养血管皮瓣修复创面,范围为13 cm×5 cm～36 cm×6 cm。供区均直接缝合。结果术后皮瓣全部成活,创面及供区Ⅰ期愈合。患者均获随访,随访时间7～23个月。皮瓣质地优良,外形、色泽良好,两点辨别觉7～12 mm。踝关节功能恢复满意,可正常穿鞋行走。结论不依赖低位穿支的单一腓动脉主穿支蒂腓肠神经营养血管皮瓣血供可靠,操作简便,创面修复平整美观,肢体功能恢复满意,适合未涉及前足的踝周、跟底中小面积软组织缺损修复,尤其适合低位缺乏满意穿支者。

Objective To investigate the operative techniques and clinical results of sural neurocutaneous vascular flap pedided on the relatively higher and main perforating branch of peroneal artery in repairing small and medium-sized soft tissue defects in ankle. Methods From July 2004 to February 2007, 14 patients （9 males and 5 females, aged 19-53 years） with small and medium-sized soft tissue defects in ankle were treated, including 4 cases of skin necrosis caused by surgery for achilles tendon rupture, 3 soft tissue defects due to car accident, 2 crush injury due to falling heaW objects, 2 chronical infectious ulcer, 2 skin necrosis cuased by surgery for calcaneus fracture and 1 melanoma resection in heel. Ranging from 4 cm× 2 cm to 9 cm × 5 cm and combing with exposure of either tendon or bone, the defects were in ankle areas （12 cases） and weigh〉bearing heel （2 cases）. The time from injury to hospitalization was 12 days to 13 months, except 3 cases of emergency hospitalization. After thorough debridement, the sural neurocutaneous vascular flaps （13 cm × 5 cm - 36 cm × 6 cm ） pedicled on the perforating branch of peroneal artery was harvested to repair the defects. The donor sites were sutured directly. Results Postoperatively all the flaps survived, and all the donor sites and wounds healed by first intention. Over a 7-23 month follow-up period, the texture, appearance and color of the flaps in all cases were good, with two-point discrimination of 7-12 ram.The function of ankle obtained satisfactory recovery with normal in-shoe gait. Conclusion With a reliable blood supply, simple operative procedure, sound repair of wound and satisfactory recovery of limb function, the sural neurocutaneous vascular flap pedicled on the relatively higher and main perforating branch of peroneal artery is applicable for the repair of small and medium-sized defects in the ankle and weight-bearing area of heel, especially for patients who have no satisfactory perforating branch in lower position.