腓动脉皮支与腓肠神经联合远端蒂皮瓣修复小儿足踝部皮肤缺损

Treatment of kid foot soft tissue defect with reverse flap with cutaneous branch of fibular artery com- bine with sural nerve nutritional vessel axial

目的探讨腓动脉皮支与腓肠神经营养血管联合远端蒂皮瓣逆行修复小儿足踝部皮肤缺损的临床应用效果。方法根据缺损部位及大小设计以腓动脉下段皮支与腓肠神经营养血管的联合远端蒂及旋转点，沿腓肠神经营养血管轴线切取皮瓣，逆行移位修复小儿足踝部皮肤软组织缺损6例。皮瓣切取范围8．0cm×7．0cm。18．0cm×10．0cm，联合血管蒂长1．7—3．0cm，血管蒂发出部位位于外踝上4．0—8．0cm。结果术后6例皮瓣其中5例完全成活，创面Ⅰ期愈合。1例远端1．0cm发生干性坏死，面积约2．0cm×1．0cm，经换药后愈合。随访6～18个月，无任何并发症，皮瓣质地优良，外观满意，行走正常，其中腓肠神经均与受区感觉神经吻合，术后1年感觉恢复可，两点辨别觉为10．0～13．0mm。结论腓动脉皮支与腓肠神经营养血管联合远端蒂皮瓣手术操作简便，血供可靠，且不过多牺牲主要动脉，切取面积大，逆转距离长，恢复一定的足踝部感觉，为临床修复小儿足踝部软组织缺损提供了一种新方法。

Objective To investigate the clinical efficiency of kid foot soft tissue defect with reverse flap with cutaneous branch of fibular artery combine with sural nerve nutritional vessel axial. Methods From Feb. 2006 to Feb. 2009, according to the position and size of the soft tissue defects, the sural nerve nutritional vessel flap combine with the cutaneous branch of the peroneal artery were desingned and obtained to repair the 5 cases soft tissue defects of the foot. The flap size ranged from 8 cm × 7 cm to 18 cm× 10 cm. The vessel pedicle of cutaneous branches ranged from 1.7 cm to 3.0 cm. The distribution of the vessel pedicle of cutaneous branches ranged from 4.5 cm to 8.0 cm on the lateral malleolus. Results All flaps survived completely in 6 cases. The outline and function were satisfactory during 6-18 months follow-up. Among of 6 cases, the sural nerve were anastomosed with the aceeptor sensory nerve in all cases. The skin sense were satisfactory after 1 year of operation and 2-point discrimination was 10-13 mm. Conclusion The blood supply of this flap is reliable without sacrifice of major arteries. Flap elevation is easy. It can reverse to a long distance and can repair large skin defects. Especially this flap could have some sensory nerve. It is very useful in repairing kid foot large soft tissue defect.