小腿远端及足踝部皮肤缺损的显微外科治疗

The Microsurgical Treatment of Skin Defect at the Distal Shank and Foot Ankle

目的观察多种皮瓣修复小腿远端及足踝软组织缺损的临床效果。方法应用皮瓣修复小腿远端及足踝软组织缺损，其中包括内踝上皮瓣、外踝上皮瓣、足底内侧皮瓣、隐神经营养血管蒂皮瓣、带隐神经胫后动脉穿支蒂皮瓣、腓肠神经营养血管蒂皮瓣、带腓肠神经的腓动脉穿支蒂皮瓣、带旋髂深血管髂骨游离皮瓣、游离的背阔肌皮瓣、股前外侧皮瓣。结果55例皮瓣中完全成活48例，部分坏死7例，成活后的皮瓣远期随访质地比较柔软，带蒂皮瓣比较薄，相对容易恢复保护性感觉。游离皮瓣一般外形臃肿，恢复保护性感觉差。结论小腿远端及足踝创面修复的皮瓣种类日渐增多，可根据临床具体情况选择合适的皮瓣来达到较满意的修复效果。

Objective To observe the curative effeet of defect soft tissue of the distal shank and foot ankle repaired with kinds of skin flap. Methods Defect soft tissue of the distal shank and foot ankle was repaired by skin flap, ineluding of supramalleolar meland flaps, supramalleolar lateral flaps, medial plantar flaps, saphenous nerve-great saphenons vein nutritional vessels, vaseularized saphenous nerve flap based branches of the posterior tibial artery, sural neurovaseular flaps, vaseularized sural nerve flap based branches of the peroneal artery, the vaseularized iliae incorporate wih deep iliae circumflex artery and vein pediele with free flap,skin flap of liber latissimus dorsi muscle,skin flap of chest umbilicus,lateral and ventral thigh. Results In the 55 eases of skin flaps, there were 48 eompletely alive eases,7 partly dead eases and one ease with dissecting failure. Most of the living skin flaps were soft and thin and were relatively easy to reeovery the proteeting sensation. The liber skin flaps were intumescent with bad protecting sensation. Conclusion The kinds of skin flaps repaired for the distal shank and foot ankle defeet gradually inerease and the suitable flaps ean be ehosen according to the clinic to get satisfactory repairing effect