高位穿支蒂腓肠神经营养血管皮瓣修复足踝部软组织缺损

Sural Neurocutaneous Vascular Flap Pedicled with Higher Perforating Branch of Peroneal Artery for Repair of Defects at Location of Ankle and Proximal Part of Foot

目的报道相对高位单一腓动脉穿支蒂腓肠神经营养血管皮瓣修复踝周及跟底负重区不同面积软组织缺损的手术方法及临床效果。方法切取以腓动脉发出最下位主穿支为蒂腓肠神经营养血管皮瓣,皮瓣远端与创面相连,血管蒂位于其中下分,旋转180°,近远端交换分别修复缺损创面及部分供区,腓肠神经与受区皮神经吻合重建感觉。结果临床应用19例,皮瓣全部成活。随访时间12～23个月,皮瓣外观满意,质地优良,两点辨别觉7～14mm,可正常穿鞋行走。结论该术式皮瓣可切取面积大,血供可靠,创面修复平整美观,肢体功能恢复满意,适合未涉及前足的足踝部软组织缺损修复,特别是低位缺乏满意穿支者。

Objective To report the operative techniques and clinical results of sural neurocutaneous vascular flap pedicled with a relatively high perforating artery for the repair of defects near the ankle without spreading to distal end of the foot. Methods A sural nearocuta- neous vascular flap pedicled with a single unit of perforating veins and artery, a main one and usually locating at a relative higher position of the leg, which provided more blood supply than those slender ones at a lower position but convenient for the flap＇s design in reconstruction of foot and ankle, was harvested to repair defects near ankle and proximal part of foot, especially those moderate defects in heel＇s weight-bearing area （n=6）. Different from normal ways, the pedicle was located at a certain part of the flap, which divided the flap into 2 parts： the skin between the perforating artery and the defects was designed as the distal part of the flap, and the proximal part was schemed according to the location, area and shape of the defects to allow a 180° rotation to cover the defects as well as part of that of donor. Sural nerve was anasto- mosed to innervate the flap. Results The flap was applied in 19 cases, all flaps were transplanted successfully without necrosis, and no vascular problems occurred. Follow-up ranged 12 to 23 months, no sore or ulcer occurred and two point discrimination had recovered to 7-14 mm with excellent results including satisfactory limb appearance as well as normal gait. Conclusion The flap has the advantages of perforator flap and neuroeutaneous flap, as well as easy dissection, delicate designation, satisfactory limb appearance and reliable blood supply. It＇ s a good choice for repairing the defects near the ankle without spreading to distal end of the foot defects including heel＇s weight-bearing area, especially those lacking perforating branch near ankle.