带蒂皮瓣、肌皮瓣修复小腿下段及足踝部皮肤软组织缺损

Repair of soft tissue defects in the lower shank, the ankle and the foot using pedicle skin flaps or myocutaneous flaps

目的:探讨应用带蒂皮瓣、肌皮瓣修复小腿和足踝部皮肤软组织缺损的疗效及其应用体会。方法:自1990年以来,我院根据68例患者创面所在具体部位、面积、创面的性质及致伤因素的不同而选择不同的皮瓣治疗小腿下段及足踝部皮肤软组织缺损,共使用股后皮神经营养血管皮瓣14例,逆行腓肠神经营养血管皮瓣19例,肌皮瓣12例,足外侧皮瓣23例。皮瓣面积5.0 cm×2.0 cm～24.0 cm×8.0 cm。结果:68例皮瓣中有65例术后全部成活,创面一期愈合,3例皮瓣远端小面积坏死,经换药后愈合。所有病例术后均随访3个月～9年,平均2年9个月,皮瓣外形、功能良好。结论:应根据小腿下段和足踝部皮肤软组织缺损的具体情况合理选择皮瓣种类。股后皮神经营养血管皮瓣,逆行腓肠神经营养血管皮瓣、肌皮瓣,足外侧皮瓣均是较理想的修复小腿下段及足踝部软组织缺损的材料。

Objective To explore the use of pedicle skin flaps or myocutaneous flaps to repair soft tissue defects in the lower shank, the ankle, and the foot. Methods According to the site, size, nature, and cause of the wound, we used different types of flaps to repair defect wounds in 68 patients, including posterior femoral cutaneous neurovascular flaps in 14, reversed sural neuroeutaneous island flaps in 19, myocutaneous flaps in 12, and lateral foot flaps in 23. The flap coverage was 5.0 cm × 2.0 cm to 24.0 cm×8.0 cm in size. Results The flap grafts survived entirely in 65 patients, with the wound healing by first intention. A small necrosis in the distant end of the flap occurred in 3 patients; but all the wounds were healed after dressing change. All patients were followed 3 months to 9 years. The flaps retained a good appearance and functioned well. Conclusions Defferent flaps should be selected depending on the state of soft tissue defects. The nervus eutanens femoris posterior pedieled flap, reversed sural neurocutaneous island flap, myoeutaneous flap, and lateral foot flap can be ideal skin grafts to repair soft tissue defects in the lower shank, the ankle, and the foot.