腓肠神经血管皮瓣修复足跟区皮肤软组织缺损

Distally based sural neurofasciocutaneous flap for repairing soft tissue defects in heel

[目的]探讨远端蒂腓肠神经营养血管皮瓣修复足跟区的特点。[方法]2002年6月～2008年7月行远端蒂腓肠神经营养血管皮瓣修复足跟区皮肤软组织缺损58例,其中创面合并有足跟部空洞形成者10例,创面位于跟底行皮神经吻合13例,皮瓣面积8 cm×4 cm～20 cm×15 cm,皮瓣的切取采用先显露穿支血管后游离皮瓣的方法。[结果]本组58例皮瓣中,46例完全存活,12例远端浅表或部分坏死,经换药、Ⅱ期缝合或植皮后创面愈合。经术后1～34个月随访,皮瓣均外观较满意,感染控制且无复发,无慢性溃疡及压疮形成,行走功能好。[结论]远端蒂腓肠神经营养血管皮瓣修复足跟区创面具有血运丰富,成活面积大,手术简单,成功率高,可重建保护性感觉的优点,大部分足跟区皮肤软组织缺损可用该皮瓣修复。

[ Objective] To investigate the characteristics of the distally based sural neurofaseiocutaneous flap for repairing soft tissue defects in heel. [ Method] From June 2002 to July 2008,58 cases of soft tissae defects in heal were repaired with distally based sural neurofascioeutaneous flaps. Among them, 10 cases combined with a dead cavity, 13 cases were innervated with the anastomosis of the sural nerve to the cutaneous nerve of recipient site. The size of the flaps ranged from 8 cm × 4 cm to 20 cm × 15 cm. The perforating barnches of peroneal artery in fascia pedicle were exposed first, and then the flaps were harvested. [ Result] Forty-six flaps survived uneventfully. Necrosis took place in the distal part in 12 flaps ,and the wounds healed after changing dressing daily, two-stage suture or skingrafting. Through 1 to 34 months of follow-up, all the survival flaps provided good contours. Infection was controlled and no recurrence, ulcer or pressure sore was found. Walk function was good. [ Conclusion ] Distally based sural neurofasciocutaneous flaps for reparing soft tissue defects have many advantages. It can offer abundant blood supply, large survival size, simple operation, high achievement rate, and re-establishment of protective sensation. The flaps can repair almost all defects in heel.