腓肠神经营养血管逆行皮瓣修复下肢软组织缺损

Reversed sural neurovascular fasciocutaneous flap for reconstruction of soft tissue defects of lower limbs

目的:探讨腓肠神经营养血管逆行皮瓣的临床应用价值。方法:2007年1月至2009年5月,10例下肢软组织缺损,男6例,女4例;年龄16～55岁,平均32岁。其中足部软组织缺损6例,骨折术后骨外露2例,小腿慢性溃疡2例。对腓肠神经血管逆行皮瓣通过显微技术吻合及结扎小隐静脉,将皮瓣近侧腓肠神经断端与患处附近的神经行端侧吻合,根据皮瓣外观、血运、质地、弹性及皮肤两点辨别觉评价术后疗效。结果:术后患者伤口愈合,无明显的并发症发生。术后随访6～24个月,平均15个月。皮瓣外观、血运、质地、弹性佳,皮肤两点辨别觉为9～12mm2PD。结论:此皮瓣切取方便,血供丰富且不牺牲主要动脉,静脉血回流通畅,成活可靠,术后恢复保留了皮瓣的感觉功能,足跟及足外侧缘无感觉丧失区,提高了生活质量。

Objective：To investigate the clinical application of the reversed sural neurovascular fasciocutaneous flap. Methods：From January 2007 to May 2009,10 patients （6 males and 4 females） with soft tissue defects on lower limbs were treated by reversed sural neurovascular fasciocutaneous flap. The end to side neuroanastomosis were used to reinnervate the flap and microsurgery was used for anastomosing small saphenous vein. The age ranged from 16 to 55 years （mean,32 years）. There were 6 patient with soft tissue defects on foot,2 patients with exposed bone after operation,2 patients with chronic ulcer on limb. The patients were evaluated with appearance,blood supply,texture and 2 PD of the flaps. Results：All the patients were followed for 6 to 24 months （mean,15 months）. The flaps in all 10 patients survived completely. The appearance,blood supply and texture of the flaps were excellent and 2 PD was 9 to 12 mm. Conclusion：This flap has sufficient blood supply and high survival rate. It also effectively retains the feeling of dorsolateral heeland improved quality of life.