腓肠神经营养血管蒂皮瓣交腿修复胫前及足部软组织缺损

Cross-leg repair for the anterior tibial and foot soft tissue defect with sural neurovascular flap

目的探讨腓肠神经营养血管蒂皮瓣交腿修复胫前及足部软组织缺损的临床疗效。方法2004年1月～2007年12月,对11例胫前及足部外伤感染后软组织缺损坏死、骨外露彻底清创后,采用腓肠神经营养血管蒂皮瓣交腿修复,胫前软组织缺损6.0cm×5.0cm～16.0cm×8.0cm;足部软组织缺损4.0cm×3.0cm～14.0cm×6.8cm,皮瓣切取范围为5.6cm×4.5cm～18.0cm×10.0cm,蒂最长达18cm。结果术后10例皮瓣Ⅰ期愈合,1例Ⅱ期愈合。随访3个月～3年,质地良好,外观较满意。足背皮瓣中1例边缘坏死,1例老年患者出现下肢交腿压疮,浅部针眼感染2例。膝、踝关节功能受影响小,皮瓣感觉仅有少部分恢复。结论腓肠神经营养血管蒂皮瓣交腿是修复胫前及足部软组织缺损的有效方法。老年患者固定时间长容易引起关节僵硬,宜慎用,交腿后注意固定及防止压疮。

Objective To explore the effect of cross - leg repair for the anterior tibial and foot soft tissue defects with sural neurovascular flap. Methods From Jan. 2004 to Dec. 2007, there were 11 cases of anterior tibial and foot injury with infection, necrosis of soft tissue defect and bone exposure. After debridement, the sural nerve nutrition blood vessels were used to repair. The size of anterior tibial soft tissue defect ranged ： 6. 0cm ×5.0cm- 16.0cm ×8.0em ; the size of foot soft tissue defect ：4. 0cm × 3. Ocm-14.0cm × 6.8cm ;flap-cut ：5.6cm × 4.5cm-18. 0cm ×10. Ocm. The longest length of pedicle was 18cm. Results After operation, 10 cases healed in stage I , 1 case in stage Ⅱ. Follow-up ranged from 3 months to 3 years with good texture and appearance. Marginal necrosis was found in 1 case;cross-leg pressure sore in 1 elderly patients;pinprick infection in 2 cases. It has small effect on knee and ankle joint function and only a small portion of flaps recovered in sensory. Conclusion Cross-leg repair for the anterior tibial and foot soft tissue defects with sural nerve nutrition blood vessel is an effective way. Longtime fixation, which easily leads to joint stiffness in elderly patients, should be used with caution. Pressure sore should also be prevented.