两种腓肠神经-小隐静脉营养血管远端蒂皮瓣修复踝足部创面(附8例报告)

Distally Based Suralneurocutaneous Flap of Two Different Blood Supply Pedicled with Saphenous Vein for Foot and Ankle Reconstruction (A Report of 8 Cases)

目的探讨以腓动脉最远侧肌间隔穿支及外踝后穿支作为两种主要血供来源的腓肠神经-小隐静脉营养血管远端蒂皮瓣修复踝足部组织缺损。方法2006年3月至2008年3月采用腓肠神经-小隐静脉营养血管远端蒂皮瓣治疗踝足部组织缺损8例,其中以腓动脉最远侧肌间隔穿支为主要血供来源6例,以外踝后血管穿支为主要血供来源2例,皮瓣面积4cm×6cm～10cm×12cm的大小。结果所有皮瓣成活,术后3例皮瓣远端部分皮肤坏死,2例换药后愈合,1例植皮后愈合。结论腓肠神经-小隐静脉营养血管远端蒂皮瓣较适用于踝足部组织缺损的修复,供区存在状态良好,邻近转移,切取方便,成活率高,外踝后穿支为主血供的皮瓣较使用于修复较小组织缺损,以腓动脉最远侧肌间隔穿支为主血供的皮瓣较适用于修复较大的组织缺损,且以外踝后穿支为主血供的皮瓣对供区影响较小,术中远端小隐静脉结扎与否对皮瓣成活率影响不大。

Objective To explore the clinical effects of suralneurocutaneous flap of two different blood supply pedicled with saphenous vein repairing soft tissue defects around the ankle. Methods 8 pateints with soft tissue defects around the ankle, foot and heel were treated with distally-based sural neurocutaneous flap pedicled with saphenous vein from March, 2006 to March, 2008. For these patients 6 were treated with flap pedicled with the farthest intermuscular septum perforating branches of peroneal artery and 2 with pedicled with the heel lateral artery. The size of largest flap was 10 cm×12 cm, while the smallest was 4 cm× 6 cm. Results The flaps survived on 8 patients according to the follow-up monthly. Partial necrosis of flaps occurred in 3 cases. Conclusions This flap has a high survival rate, while the dissection is easy and quick in stable position. It can be used reliably for reconstructing the soft tissue defects around distal tibia, the heel and the ankle.